Mild IgA nephropathy is histologically defined as focal GW2580 molecular weight mesangial proliferation. Severe IgA nephropathy is histologically defined as diffuse mesangial proliferation or more than 50 % of the glomeruli containing crescents. 2. Treatment for mild IgA nephropathy   We recommend ACE inhibitors as the first choice of agent for treating mild IgA nephropathy, because they reduce urinary protein excretion and inhibit the progression of IgA nephropathy. We suggest that ARBs are useful

for treating mild IgA nephropathy, because they may reduce urinary protein excretion. Currently available evidence does not support the conclusion that combination therapy with an ACE inhibitor and an ARB is essential in the treatment of mild IgA nephropathy. Therefore, https://www.selleckchem.com/products/nec-1s-7-cl-o-nec1.html we do not recommend combination therapy with an ACE inhibitor and an ARB for treating mild IgA nephropathy. The physician should decide on the doses of an ACE inhibitor or an ARB with reference to the doses used as antihypertensive agents for children (Section 17 CQ5). The physician should start with low doses of an ACE inhibitor or an ARB and increase the dose while carefully monitoring the patient for side effects. 3. Treatment for severe IgA nephropathy   We recommend combined therapy with prednisolone, an immunosuppressive agent (azathioprine or mizoribine), warfarin and dipyridamole for 2 years for severe IgA nephropathy (Table 14). Two RCTs and one clinical trial in pediatric

patients with severe IgA nephropathy have demonstrated that this regimen can reduce urinary protein excretion and inhibit the progression of glomerular sclerosis. Two cohort studies have demonstrated that this regimen can improve the long-term prognosis of children with severe IgA nephropathy. Table 14 Combined therapy for 2 years (1) Prednisolone (2) Immunosuppressive agent  Oral administration of 2 mg/kg Endonuclease per dose (max 100 mg) of azathioprine one time per day or 4 mg per dose (max 150 mg) of mizoribine one or two times per day (3) Warfarin  Oral administration of warfarin one time per day.

Regulate the dose of warfarin using the thrombo test with a target range of 20–50 % (4) Dipyridamole  Start oral administration of 3 mg/kg per dose of dipyridamole three times per day; if there are no side effects, increase the dose to 6–7 mg/kg per dose (max 300 mg) 4. Tonsillectomy for IgA nephropathy   Reports of tonsillectomy in children have come from predominantly retrospective studies and have not included adequate controls. It is difficult to interpret the data, because most of the patients reported in these studies also received concomitant medications, such as corticosteroids. We recommend that a conservative approach be maintained for children with recurrent gross hematuria unless they have additional risk factors, including a history of frequent episodes of tonsillitis or massive proteinuria. Bibliography 1. Yata N, et al. Pediatr Nephrol.