IgA nephropathy: what's new?

Although IgA nephropathy has only been recognized as a definitive entity for fewer than 40 years, its place in the world as a prominent cause for progressive kidney disease is well established. The extent to which we understand the role of genetically derived abnormal forms of the IgA molecule in the disease is evolving, and this will, hopefully, translate into more specific modes of treatment for patients in the future. In the meantime, we have few specific therapeutic options, most of which have not been well studied in large numbers of patients. The extent to which we can define which patients are likely to progress--and hence should be considered candidates for treatment--will be discussed in this Commentary. In addition, the notion that some patients may have reached "the point of no return" will also be addressed. Unfortunately, most of the comments will be based on results obtained in studies conducted in adults--a situation that is very familiar to pediatric nephrologists.