• Thomas M. Specific management of IgA nephropathy: role of cyclosporin and other therapies. Nephrology 2006 Apr;11(S1):S149-53.



• Thomas M. Specific management of IgA nephropathy: role of cyclosporin and other therapies. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Sep. 8 p. [15 references]

This is the current release of the guideline.

• Immunoglobulin A (IgA) nephropathy
• Renal impairment
• Chronic kidney disease
• End-stage kidney disease

Management
Treatment

Family Practice
Internal Medicine
Nephrology
Pediatrics

Physicians

To summarize evidence for the utility of these agents in patients with immunoglobulin A (IgA) nephropathy

Adults and children with immunoglobulin A (IgA) nephropathy

The use of cyclosporin A, mycophenolate mofetil, vitamin E, and fluvastatin were considered but not recommended.

• Remission of proteinuria
• Renal function decline

Searches of Electronic Databases

Databases searched: MeSH terms and text words for IgA nephropathy were combined with MeSH terms and text words for cyclosporin, vitamin E, fluvastatin and azathioprine. This search was carried out in Medline (1966 to September Week 2 2004). The Cochrane Renal Group Trials Register was also searched for trials of IgA nephropathy not indexed in Medline.

Date of searches: 17 September 2004.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding the role of cyclosporin and other therapies in the management of immunoglobulin (IgA) nephropathy from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, UK Renal Association, Canadian Society of Nephrology, European Best Practice Guidelines, and International Guidelines.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

There is currently insufficient data to support the use of cyclosporine to slow the progression of immunoglobulin A (IgA) nephropathy. (Level I evidence)

Suggestions for Clinical Care

(Suggestions are based on Level III and IV evidence)

• In patients with IgA nephropathy and nephrotic syndrome that have proved resistant to conventional treatment, clinical remission in selected patients has been reported following the use of cyclosporin, azathioprine, mycophenolate and intravenous immunoglobulin, ketoconazole and mizobine. These anecdotal reports do not provide conclusive evidence of their efficacy in preventing disease progression in IgA nephropathy and further studies are needed before these treatments can be recommended. (Level III evidence - anecdotal reports, uncontrolled and retrospective reviews).
• Although their utility in preventing progressive renal impairment remains to be established, fluvastatin appears to have antiproteinuric effects in patients with IgA nephropathy. In the presence of dyslipidemia, which complicates many cases of IgA nephropathy, it seems reasonable to consider a statin as a first-line therapy.
• Similarly, while the clinical utility of vitamin E therapy in preventing progressive renal impairment remains to be established, its good side-effect profile means that some patients will wish to consider vitamin E supplementation in addition to other relevant supportive strategies.

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate management of patients with immunoglobulin A (IgA) nephropathy

Not stated

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Thomas M. Specific management of IgA nephropathy: role of cyclosporin and other therapies. Nephrology 2006 Apr;11(S1):S149-53.



• Thomas M. Specific management of IgA nephropathy: role of cyclosporin and other therapies. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Sep. 8 p. [15 references]

Not applicable: The guideline was not adapted from another source.

2005 Sep

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Author: Merlin Thomas

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on May 19, 2008. The information was verified by the guideline developer on June 11, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.