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Therapeutic aspects of IgA nephropathy: an overview
Author(s) -
Schena Francesco P,
Strippoli Giovanni FM,
Manno Carlo
Publication year - 2002
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1046/j.1440-1797.7.s3.12.x
Subject(s) - medicine , microhematuria , randomized controlled trial , meta analysis , proteinuria , nephropathy , concordance , renal function , creatinine , kidney , endocrinology , diabetes mellitus
SUMMARY:IgA nephropathy (IgAN) is the cause of end‐stage renal failure in 15–20% of patients within 10 years from the apparent onset of the disease and in 30–40% of individuals within 20 years. The degree of renal lesions, serum creatinine, severe proteinuria and microhematuria are independent prognostic indicators. No specific therapy has been definitely established, although several approaches have been experimented. The most important aspects of each randomized controlled trial (RCT) available in the literature were analysed regarding the treatment of IgAN with corticosteroids, cytotoxic agents and fish oil. Their quality was evaluated according to the Consolidated Standards of Reporting Trials (CONSORT) statement, an analysis was performed of heterogeneity between trials and finally these results were used to obtain a meta‐analysis adjusted for the duration of follow up. Regarding the quality assessment of the considered trials, the analysis showed that the majority of RCT lack key information, particularly in their methods and results sections. Because a wide heterogeneity existed among RCT, the meta‐analysis was performed with both fixed and random methods to obtain the most reliable results. The present study showed that only corticosteroid treatment may be beneficial for the outcome of renal function, while this is only partially true for fish‐oil treatment and not true for cytotoxic agents. These statements are in concordance with previously published meta‐analyses. Furthermore, when the results of meta‐analysis on the effect of treatment for corticosteroids, cytotoxic agents and fish oil were adjusted for the duration of follow up, it was found that their effects decreased and became null as follow up increased. In conclusion, further RCT are necessary, including more homogeneous groups of IgAN patients and therapeutic regimens with a long‐term follow up. It is necessary to state that the results of meta‐analysis must be used with care and not as a surrogate for sound decision‐making. They should not be considered as absolute, and this is particularly true in fields such as nephrology in which the number of patients enrolled in individual studies is very small and the duration of follow up is very short.