"Immunoglobulin A(IgA) is characterized by a high incidence in young people, and treatment options have been relatively scarce for a long time." Recently, when talking about the characteristics and diagnosis and treatment status of IgA nephropathy in China, Professor Chen Nan of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine said so.
IgA nephropathy is a common primary glomerular disease. In addition to the large number of patients, Chinese IgA nephropathy population has more serious pathological changes and faster disease progression. Early diagnosis, early intervention, the focus of prevention and treatment should be moved forward, and the right medication has become the consensus of clinical experts.
It occurs in young adults with rapid growth and rapid disease progression
Chen Nan said that China has a high incidence of glomerulonephritis, with nearly 100,000 kidney biopsies every year, and most of the patients with primary glomerulonephritis are IgA nephropathy.
Talking about the causes of the disease, Zhang Peng, professor of Shaanxi Provincial People's Hospital, said that IgA nephropathy and other glomerulonephritis of the onset, there are genetic background factors, there are environmental factors.
He stressed that IgA nephropathy has regional and ethnic differences, and the spectrum of kidney disease in China is different from that in Europe and the United States.
In Europe and the United States, the diseases caused by metabolic diseases such as diabetes and hypertension dominate. IgA nephropathy is a rare disease in the United States, but in China, it is mainly caused by primary glomerular diseases, of which IgA nephropathy accounts for about 35% to 50%.
"IgA nephropathy is an immune disease, but it is also affected by lifestyle, diet, infection and other factors." Zhang Peng told reporters.
It is important to note that the kidney is not just an excretory organ, it is also an endocrine organ. When renal function damage is serious, in addition to causing heart failure and other cardiovascular and cerebrovascular complications, it can also lead to hypertension, anemia and calcium and phosphorus metabolism disorders.
"It looks like a chronic kidney disease, but in the body as a whole, it affects the digestive system, the blood system, the nervous system, the cardiovascular system, including many patients with itchy skin." Zhang Peng introduced.
Zhou Xiaoling, a professor at the General Hospital of Ningxia Medical University, said IgA nephropathy occurs in young adults, young adults are the pillar of the family and expectations, "once the patient is not effectively treated, it may develop into uremia, which is a relatively big challenge for clinicians."
Experts call for early initiation of treatment
Experts said that IgA nephropathy patients are mainly young and middle-aged, if the disease is not well controlled, the vast majority of patients will progress to end-stage renal disease in 10-15 years, requiring dialysis or kidney transplantation to maintain life.
In the past, the domestic treatment for IgA nephropathy mainly included renin-angiotensin system (RAS) inhibitors and SGLT-2 inhibitors, as well as systemic hormone and immunosuppressive therapy.
Zhang Peng said, "Because the onset of IgA nephropathy is more insidious, many people ignore the atypical symptoms of IgA nephropathy in the early stage, such as mild edema, hematuria and so on.
Secondly, there is a lack of understanding of the severity of the disease, even if the screening is abnormal, many people do not feel uncomfortable, do not affect the normal life will not pay attention to. But the kidney is a very strong compensatory organ, if the kidney function is left 50%, there is often no clinical performance."
"On the one hand is the treatment of the primary disease, such as proteinuria, hematuria control and protection of kidney function, on the other hand is the treatment of high risk complications such as hypertension and diabetes that occur with the decline of kidney function. So these patients must start early treatment." Chen Nan said.
She believes that the focus of the treatment of IgA nephropathy should be moved forward, IgA nephropathy must first be clearly diagnosed, and must combine pathology and clinical.
"Early treatment should minimize proteinuria and maintain stable kidney function. It is necessary to diagnose as early as possible, intervene as early as possible, move the focus of prevention and control, and use drugs for causes."
Zhou Xiaoling stressed that attaching importance to the comprehensive management of IgA nephropathy, early diagnosis, targeted intervention, precision treatment, and early use of the cause of IgA nephropathy therapy are conducive to reducing the risk of patients progressing to uremia.
