An Update on Novel Targeted Treatments for IgA Nephropathy
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Abstract
Immunoglobulin A nephropathy (IgAN) stands as the most prevalent primary glomerular disease globally. Its pathogenesis is multifaceted, primarily characterized by elevated circulating levels of Gd-IgA1, which is targeted by autoantibodies. This interaction leads to the formation of circulating immune complexes that subsequently deposit in the glomeruli, triggering intrarenal inflammation. Current therapeutic approaches primarily focus on conservative measures, such as optimized control of blood pressure and proteinuria, aimed at enhancing renal function. Additionally, immunosuppressive therapy, including corticosteroids, may be considered for patients exhibiting persistent proteinuria (>1 g/day) after a minimum of 90 days of conservative management. Recent advancements have led to the development of novel drugs targeting the underlying pathogenic mechanisms of IgAN, particularly those involving immune response and mucosal immunity, with the goal of reducing Gd-IgA1 levels and immune complex deposition in the glomeruli. Furthermore, other treatments, including drugs affecting the complement pathway, endothelin-1 receptor inhibitors, and SGLT2 inhibitors, have demonstrated potential in reducing proteinuria and kidney inflammation. These emerging strategies are promising improving outcomes in IgAN.
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