Should all patients with immunoglobulin a nephropathy receive treatment?
No. The approach to therapy in individual patients should take into account their relative risk of progression and their clinical and pathologic findings as well as a careful assessment of the potential risks and benefits of therapy.
• Patients with isolated hematuria, no proteinuria, and a normal GFR do not require treatment; however, monitoring every 6 to 12 months for potential indicators of worsening disease (such as increasing proteinuria, blood pressure, and/or serum creatinine) is warranted.
• For patients with persistent proteinuria >500–1000 mg/day, angiotensin inhibition is recommended with ACEI and/or ARB therapy, aiming for reduction in proteinuria to <500 to 1000 mg/d.
• Many physicians advocate the use of fish oil supplements because of their lack of toxicity and because they may provide a nonspecific anti-inflammatory/vasoprotective effect. However, it must be noted that randomized trials using fish oil have yielded conflicting results.
