IgA肾病精准治疗策略的探索

Recent advances of precise treatment strategies for IgA nephropathy

IgA肾病(IgA nephropathy,IgAN)是最常见的原发性肾小球疾病之一。由于病因不清、发病机制未明、临床表现多样化及预后的差异性,IgAN目前尚缺乏统一的治疗方案,因此,迫切需要识别高危进展性的IgAN,对IgAN进行分层管理和精准治疗。2020版KDIGO临床实践指南草案建议,优化支持治疗及肾素-血管紧张素系统(renin-angiotensin system,RAS)受体阻滞剂的使用仍是基础。本文总结了近年的随机对照研究,将从IgAN的临床表型和发病机制两方面进行分层,阐述其精准治疗策略,为临床治疗IgAN提供建议和依据。新型靶向治疗也许是未来的方向。

IgA nephropathy(IgAN)is one of the most common primary glomerulopathy.However,its etiology and pathogenesis have remained elusive.Clinical manifestations and tissue pathology of IgAN are diverse and its prognosis varies greatly.Currently no unified treatment is available for IgAN.Due to an urgent need of identifying high-risk progressive IgAN,hierarchical management and precise treatment of IgAN are preferred.According to the public review draft of 2020 KDIGO Clinical Practice Guideline on IgAN,primary focus of management should be optimized supportive care.This review summarized the latest findings of randomized controlled studies,stratified IgAN according to clinical manifestations and pathogenesis,briefly described treatment protocols and provided rationales for future precise treatment of IgAN.