Adult primary IgA nephropathy and common viral infections

Secondary IgA nephropathy

IgA nephropathy (IgAN) is the most common pattern of primary glomerulonephritis seen in the Western world. In the majority of cases the cause remains unknown. Cases of familial IgAN and secondary IgAN have been reported and these have provided insights into underlying genetic and environmental triggers for this common glomerular disease. Secondary IgAN is seen most commonly in patients with liver disease or mucosal inflammation, in particular affecting the gastrointestinal tract. A number of dietary and microbial antigens have been identified in circulating IgA immune complexes and mesangial IgA deposits, suggesting that environmental factors may play a role in the pathogenesis of IgAN. There is an increasing literature reporting associations between IgAN and other diseases. Whether these reports represent chance associations or genuine shared pathophysiology is discussed.

Use of corticosteroids, other immunosuppressive therapies, and tonsillectomy in the treatment of IgA nephropathy

Because IgA nephropathy (IgAN) was originally regarded as a benign condition, the indication of corticosteroids or other immunosuppressive therapies have been highly restricted because of potential side effects, and such drugs have been used for a specific subgroup of patients with IgAN, taking the risk/benefit ratio into consideration. During the last decade, however, with the recognition that the overall long-term prognosis of IgAN is a nonbenign condition, more aggressive treatments, including high-dose corticosteroids, various immunosuppressive agents, and tonsillectomy, have been used for wider subgroups of patients with IgAN. Moreover, recent studies have suggested that clinical remission as well as histopathologic regression of the nephropathy could be obtained by such treatments if treatment is initiated in its relatively early stage. Thus, the possibility has now been raised that the goal of treatment for patients with IgAN will shift from "slowing the progression of nephropathy" to "remission of nephropathy."

Glomerular disease in the tropics

Glomerular disease in the tropics differs considerably from that in temperate climates and between the developed and the developing world. The prevalence and pattern of glomerular disease in the tropics in turn varies widely in different geographic regions and is influenced by environmental, nutritional, and socioeconomic factors. Among the infective agents that have been identified as contributing to an increased prevalence of glomerular disease in the tropics are Plasmodium malaria, Schistsomiasis mansoni, Mycobacterium leprosy, and hepatitis B virus (HBV). A decline in the prevalence can only be expected with the eradication of infections. Accurate knowledge of the prevalence, histologic features, and causes is essential to achieve prevention and management of glomerular diseases in the tropics.