• Thomas M. Specific management of IgA nephropathy: role of triple therapy and cytotoxic therapy. Nephrology 2006 Apr;11(S1):S141-5.



• Thomas M. Specific management of IgA nephropathy: role of triple therapy and cytotoxic therapy. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Sep. 11 p. [14 references]

This is the current release of the guideline.

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

Guidelines

1. Triple therapy with cyclophosphamide, dipyridamole, and warfarin has not been shown to be superior to conventional treatment as sole therapy in patients with immunoglobulin A (IgA) nephropathy. (Level II evidence)
2. Treatment with cyclophosphamide and prednisolone is superior to supportive treatment alone in patients with IgA nephropathy. (Level II evidence)

Suggestions for Clinical Care

(Suggestions are based on Level III and IV evidence)

• There is currently no evidence to demonstrate that the addition of azathioprine, cyclophosphamide, dipyridamole, or warfarin, alone or in combination, with corticosteroids has any additive benefit. At the same time, these therapies expose patients to significant toxicity. Gonadal toxicity makes this treatment a concern in young patients. (Level IV evidence)
• The specific utility of these agents in patients with steroid-resistant nephrotic syndrome due to IgA nephropathy remains to be tested in clinical studies. However, a number of case series have shown that remission can be induced by pulse cyclophosphamide in some steroid resistant patients. (Level IV evidence)

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").

• Thomas M. Specific management of IgA nephropathy: role of triple therapy and cytotoxic therapy. Nephrology 2006 Apr;11(S1):S141-5.



• Thomas M. Specific management of IgA nephropathy: role of triple therapy and cytotoxic therapy. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Sep. 11 p. [14 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 16, 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.