Behandlung der chronischen Nierenkrankheit bei IgA-Nephropathie

Die Immunglobulin-A-Nephropathie galt in der Vergangenheit als hauptsächlich gutartig, doch inzwischen weiß man, dass viele Patienten im Verlauf dialysepflichtig werden. Traditionelle Behandlungen mit Renin-Angiotensin-Aldosteron-System (RAAS)-Hemmern und neuere Therapien wie z.B. SGLT2-Inhibitoren werden hinsichtlich ihrer Rolle bei der Verringerung der Proteinurie und dem Erhalt der Nierenfunktion diskutiert.

Abstract

This article provides an overview of treatment approaches for chronic kidney disease (CKD) in patients with IgA nephropathy (IgAN). IgAN is the most common primary glomerulonephritis and results from an autoimmune reaction to aberrantly glycosylated immunoglobulin A (IgA) antibodies. Although historically considered largely benign, it is now recognized that a significant percentage of patients develop dialysis-dependent kidney disease over the years. Traditional treatments with RAAS inhibitors and newer therapies such as SGLT2 inhibitors, endothelin receptor antagonists, and delayed release, primarily locally acting enteric corticosteroids regarding their role in reducing proteinuria and preserving kidney function are also discussed. Additionally, non-immunosuppressive options and lifestyle modifications are examined for their potential to slow disease progression. Further promising medications are currently in clinical trials, including complement inhibitors and immunomodulators. These emerging therapies offer hope for significantly improving the prognosis of IgAN in the future. By presenting a comprehensive overview of current and potential future treatment strategies, this review aims to provide clinicians with up-to-date information to optimize the management of CKD in patients with IgAN.

Kernaussagen

• Die Behandlung der IgA-Nephropathie entwickelt sich dank eines besseren Verständnisses ihrer Pathogenese aktuell rasch weiter.

• Mehrere neue Behandlungsstrategien befinden sich in der klinischen Entwicklung; viele davon sind spezifisch auf die pathogenetischen Prozesse der Krankheit zugeschnitten.

• Die Behandlung der IgA-Nephropathie wird zukünftig wahrscheinlich zum einen immunologische Mechanismen und zum anderen die CKD-Progression adressieren.

• Die Behandlung von Patienten mit IgA-Nephropathie sollte sich auf eine optimale unterstützende Therapie und sekundäre Prophylaxe konzentrieren, bei der Lebensstil-Modifikationen, blutdrucksenkende Maßnahmen und die Reduktion der Proteinurie im Mittelpunkt stehen.

Schlüsselwörter

IgA-Nephropathie - chronische Nierenerkrankung - Glomerulonephritis - Renin-Angiotensin-Aldosteron-System - Proteinurie - Komplementinhibitoren - Immunmodulatoren

Keywords

IgA nephropathy - chronic kidney disease - glomerulonephritis - renin-angiotensin-aldosterone system - proteinuria - complement inhibitors - immunomodulators

Publikationsverlauf

Artikel online veröffentlicht:
14. Januar 2025

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