Diagnosis and Prognosis
Practice Point 2.3.1
Considerations for treatment of all patients with IgAN who do not have a
variant form of primary IgAN
• The primary focus of management should be optimized supportive care.
• Assess cardiovascular risk and commence appropriate interventions as
necessary.
• Give lifestyle advice, including information on dietary sodium restriction,
smoking cessation, weight control, and exercise, as appropriate.
• Other than dietary sodium restriction, no specific dietary intervention has
been shown to alter outcomes in IgAN.
• Variant forms of IgAN: IgA deposition with minimal-change disease (MCD),
IgAN with acute kidney injury (AKI), and IgAN with rapidly progressive
glomerulonephritis (RPGN) may require specific immediate treatment.
Practice Point 2.2.1
Considerations for the prognostication of primary IgA
• Clinical and histologic data at the time of biopsy can be used to risk stratify
patients.
• The International IgAN Prediction Tool is a valuable resource to quantify risk of
progression and inform shared decision-making with patients.
• The International IgAN Prediction Tool incorporates clinical information at
the time of biopsy and cannot be used to determine the likely impact of any
particular treatment regimen.
• There are no validated prognostic serum or urine biomarkers for IgAN other
than estimated glomerular filtration rate (eGFR) and proteinuria.
Recommendation 2.3.1
We recommend that all patients have their blood pressure managed
as described in Chapter 1. If the patient has proteinuria >0.5 g/d
we recommend that initial therapy be with either an angiotensin-
converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker
(ARB) (Recommendation Grading 1B — Moderate Recommendation).
Treatment
