{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T08:14:04Z","timestamp":1784448844438,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>IgA nephropathy (IgAN), the most common primary glomerulonephritis worldwide, is characterized by a mesangial IgA deposit and a variety of histological lesions, as described by the Oxford classification system. Despite the well-described \u201cfour-hit hypothesis\u201d, there are still plenty of less or undescribed mechanisms that participate in the disease pathogenesis, such as B-cell priming, which seems to be initiated by different antigens in the intestinal microbiota. Diagnosis of the disease is currently based on kidney biopsy findings, as the sensitivity and specificity of the many serum and urinary biomarkers described so far do not seem to have diagnostic accuracy. Therapeutic strategies consist of the initial step of non-immune medication, aiming to reduce both the intraglomerular pressure and proteinuria to below 0.5 g\/day, followed by systemic corticosteroid administration in patients who remain at high risk for progressive chronic kidney disease despite the maximum non-immune treatment. The 6-month systemic corticosteroid treatment reduces proteinuria levels; however, the increased possibility of adverse events and increased relapse rate after treatment raises the need for a new therapeutic approach. Targeted-release budesonide is a therapeutic modality that aims to inhibit disease pathogenetic pathways at early stages; it has minor systemic absorption and proven beneficial effects on renal function and proteinuria. In the present systemic review, the benefits and adverse events of steroids and budesonide are described, and the possibility of combined treatment is questioned in selected cases with active histologic lesions.<\/jats:p>","DOI":"10.3390\/diagnostics14050512","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T06:14:22Z","timestamp":1709100862000},"page":"512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Diagnosing and Treating IgAN: Steroids, Budesonide, or Maybe Both?"],"prefix":"10.3390","volume":"14","author":[{"given":"Christodoulos","family":"Keskinis","sequence":"first","affiliation":[{"name":"Department of Nephrology, Papageorgiou General Hospital, 56429 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6874-7173","authenticated-orcid":false,"given":"Eleni","family":"Moysidou","sequence":"additional","affiliation":[{"name":"1st Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9565-6931","authenticated-orcid":false,"given":"Michalis","family":"Christodoulou","sequence":"additional","affiliation":[{"name":"1st Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Pateinakis","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Papageorgiou General Hospital, 56429 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2496-9863","authenticated-orcid":false,"given":"Maria","family":"Stangou","sequence":"additional","affiliation":[{"name":"1st Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2000). Intercapillary deposits of IgA-IgC: [Berger J, Hinglais N: J. Urol. Nephrol. (Paris) 74:694\u2013695, 1968 (with comments by Liliane Striker)]. J. Am. Soc. Nephrol., 11, 1957\u20131959. Available online: https:\/\/journals.lww.com\/jasn\/pages\/articleviewer.aspx?year=2000&issue=10000&article=00022&type=Fulltext.","DOI":"10.1681\/ASN.V11101957"},{"key":"ref_2","first-page":"709","article-title":"The commonest glomerulonephritis in the world: IgA nephropathy","volume":"64","year":"1987","journal-title":"Q. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Knoppova, B., Reily, C., King, R.G., Julian, B.A., Novak, J., and Green, T.J. (2021). Pathogenesis of IgA Nephropathy: Current Understanding and Implications for Development of Disease-Specific Treatment. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194501"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"16001","DOI":"10.1038\/nrdp.2016.1","article-title":"IgA nephropathy","volume":"2","author":"Lai","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"de Sousa-Pereira, P., and Woof, J.M. (2019). IgA: Structure, Function, and Developability. Antibodies, 8.","DOI":"10.3390\/antib8040057"},{"key":"ref_6","unstructured":"(2023, November 20). Immunoglobulin A\u2014An Overview|ScienceDirect Topics. Available online: https:\/\/www.sciencedirect.com\/topics\/immunology-and-microbiology\/immunoglobulin-a."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1038\/ki.2011.501","article-title":"An update on the pathogenesis and treatment of IgA nephropathy","volume":"81","author":"Boyd","year":"2012","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1038\/mi.2011.39","article-title":"Structure and function relationships in IgA","volume":"4","author":"Woof","year":"2011","journal-title":"Mucosal Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s00281-021-00871-y","article-title":"The mucosal immune system and IgA nephropathy","volume":"43","author":"Gesualdo","year":"2021","journal-title":"Semin. Immunopathol."},{"key":"ref_10","unstructured":"Delves, P.J., and Roitt, I.M. (1998). Encyclopedia of Immunology, Academic Press. [2nd ed.]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1046\/j.1523-1755.2001.060003969.x","article-title":"Mesangial IgA1 in IgA nephropathy exhibits aberrant O-glycosylation: Observations in three patients","volume":"60","author":"Allen","year":"2001","journal-title":"Kidney Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s00281-021-00888-3","article-title":"Current treatment of IgA nephropathy","volume":"43","author":"Floege","year":"2021","journal-title":"Semin. Immunopathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e31219","DOI":"10.1097\/MD.0000000000031219","article-title":"IgA nephropathy pathogenesis and therapy: Review & updates","volume":"101","author":"Habas","year":"2022","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2021.05.021","article-title":"KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases","volume":"100","author":"Rovin","year":"2021","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S2213-8587(20)30369-7","article-title":"Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: A prespecified analysis from the DAPA-CKD trial","volume":"9","author":"Wheeler","year":"2021","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.kint.2021.04.002","article-title":"SGLT-2 inhibition in IgA nephropathy: The new standard of care?","volume":"100","author":"Barratt","year":"2021","journal-title":"Kidney Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1053\/j.ajkd.2019.02.022","article-title":"Antimalarials in IgA Nephropathy: Did Our Supportive Therapy Armamentarium Just Increase?","volume":"74","author":"Floege","year":"2019","journal-title":"Am. J. Kidney Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1007\/s00467-017-3628-1","article-title":"Inflammation in IgA nephropathy","volume":"32","author":"Rauen","year":"2017","journal-title":"Pediatr. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1056\/NEJMoa1415463","article-title":"Intensive Supportive Care plus Immunosuppression in IgA Nephropathy","volume":"373","author":"Rauen","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1053\/j.ajkd.2008.07.029","article-title":"Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: A randomized controlled trial","volume":"53","author":"Lv","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1053\/j.ajkd.2010.02.351","article-title":"Cigarette smoking and progression of IgA nephropathy","volume":"56","author":"Yamamoto","year":"2010","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/S0272-6386(03)00194-X","article-title":"Controlled, prospective trial of steroid treatment in IgA nephropathy: A limitation of low-dose prednisolone therapy","volume":"41","author":"Katafuchi","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1001\/jama.2022.5368","article-title":"Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial","volume":"327","author":"Lv","year":"2022","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"FRD18","DOI":"10.2217\/frd-2021-0013","article-title":"Nefecon (Targeted-Release Formulation-Budesonide) for the Treatment of IgA Nephropathy","volume":"1","author":"Rimoldi","year":"2021","journal-title":"Future Rare Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"926517","DOI":"10.3389\/fimmu.2022.926517","article-title":"Current knowledge of targeted-release budesonide in immunoglobulin A nephropathy: A comprehensive review","volume":"13","author":"Liao","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_26","first-page":"935","article-title":"Steroid Therapy in IgA Nephropathy: A Prospective Pilot Study in Moderate Proteinuric Cases","volume":"61","author":"Kobayashi","year":"1986","journal-title":"QJM Int. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1681\/ASN.2016060647","article-title":"Corticosteroids in IgA Nephropathy: Lessons from Recent Studies","volume":"28","author":"Coppo","year":"2017","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1159\/000414332","article-title":"The secretory immune system","volume":"39","author":"Vaerman","year":"1987","journal-title":"Antibiot. Chemother. (1971)"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1155\/S0962935196000269","article-title":"Dimeric and polymeric IgA, but not monomeric IgA, enhance the production of IL-6 by human renal mesangial cells","volume":"5","author":"Reterink","year":"1996","journal-title":"Mediat. Inflamm."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1093\/ndt\/gfm581","article-title":"Synthesis of TNF-alpha by mesangial cells cultured with polymeric anionic IgA--role of MAPK and NF-kappaB","volume":"23","author":"Leung","year":"2008","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"475","DOI":"10.2174\/1566524054553450","article-title":"Molecular basis of IgA nephropathy","volume":"5","author":"Lai","year":"2005","journal-title":"Curr. Mol. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1038\/nri3322","article-title":"New concepts in the generation and functions of IgA","volume":"12","author":"Pabst","year":"2012","journal-title":"Nat. Rev. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"815","DOI":"10.2215\/CJN.12991117","article-title":"Glucocorticoids in the Treatment of Glomerular Diseases","volume":"13","author":"Ponticelli","year":"2018","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1053\/j.ajkd.2021.12.011","article-title":"Principles of Immunosuppression in the Management of Kidney Disease: Core Curriculum 2022","volume":"80","author":"Kant","year":"2022","journal-title":"Am. J. Kidney Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1038\/ki.2012.280","article-title":"The KDIGO practice guideline on glomerulonephritis: Reading between the (guide)lines\u2014Application to the individual patient","volume":"82","author":"Radhakrishnan","year":"2012","journal-title":"Kidney Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.semnephrol.2018.05.020","article-title":"The Gut-Renal Connection in IgA Nephropathy","volume":"38","author":"Coppo","year":"2018","journal-title":"Semin. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1084\/jem.157.2.572","article-title":"Experimental IgA nephropathy induced by oral immunization","volume":"157","author":"Emancipator","year":"1983","journal-title":"J. Exp. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1056\/NEJM198610303151819","article-title":"Dietary gluten and primary IgA nephropathy","volume":"315","author":"Coppo","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3237","DOI":"10.1093\/ndt\/gfr052","article-title":"New treatment for IgA nephropathy: Enteric budesonide targeted to the ileocecal region ameliorates proteinuria","volume":"26","author":"Smerud","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_40","first-page":"1","article-title":"Effect of pulsed intravenous methylprednisolone with alternative low-dose prednisone on high-risk IgA nephropathy: A 18-month prospective clinical trial","volume":"12","author":"Li","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liang, M., Xiong, L., Li, A., Zhou, J., Huang, Y., Huang, M., Zhang, X., Shi, H., Su, N., and Wei, Y. (2022). The effectiveness and safety of corticosteroid therapy for IgA nephropathy with crescents: A prospective, randomized, controlled study. BMC Nephrol., 23.","DOI":"10.1186\/s12882-022-02661-6"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.1681\/ASN.2014070697","article-title":"Corticosteroids in IgA Nephropathy: A Retrospective Analysis from the VALIGA Study","volume":"26","author":"Tesar","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1111\/jpc.14259","article-title":"Childhood IgA Nephropathy Successfully Treated with Targeted-Release Budesonide: A Case Report","volume":"54","author":"Venettacci","year":"2018","journal-title":"J. Paediatr. Child Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e21000","DOI":"10.1097\/MD.0000000000021000","article-title":"Budesonide versus systemic corticosteroids in IgA Nephropathy: A retrospective, propensity-matched comparison","volume":"99","author":"Ismail","year":"2020","journal-title":"Medicine"},{"key":"ref_45","first-page":"803","article-title":"Pharmacokinetics of budesonide (Entocort EC) capsules for Crohn\u2019s disease","volume":"43","author":"Andersson","year":"2004","journal-title":"Clin. Pharmacokinet."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"467","DOI":"10.2215\/CJN.01020905","article-title":"Clinical trial to evaluate omega-3 fatty acids and alternate day prednisone in patients with IgA nephropathy: Report from the Southwest Pediatric Nephrology Study Group","volume":"1","author":"Hogg","year":"2006","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"20119","DOI":"10.1038\/s41598-023-47393-1","article-title":"An open-label study evaluating the safety and efficacy of budesonide in patients with IgA nephropathy at high risk of progression","volume":"13","author":"Vornicu","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1016\/S0140-6736(17)30550-0","article-title":"Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): A double-blind, randomised, placebo-controlled phase 2b trial","volume":"389","author":"Barratt","year":"2017","journal-title":"Lancet"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/S0140-6736(23)01554-4","article-title":"Efficacy and safety of a targeted-release formulation of budesonide in patients with primary IgA nephropathy (NefIgArd): 2-year results from a randomised phase 3 trial","volume":"402","author":"Lafayette","year":"2023","journal-title":"Lancet"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1093\/ndt\/gfz249","article-title":"Systemic corticosteroids and mucosal-associated lymphoid tissue-targeted therapy in immunoglobulin A nephropathy: Insight from the NEFIGAN study","volume":"35","author":"Coppo","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1681\/ASN.2021010082","article-title":"Dialysis and Total Health Care Costs in the United States and Worldwide: The Financial Impact of a Single-Payer Dominant System in the US","volume":"32","author":"Pockros","year":"2021","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"213","DOI":"10.2147\/CEOR.S389456","article-title":"Cost-Effectiveness Analysis of Nefecon versus Best Supportive Care for People with Immunoglobulin A Nephropathy (IgAN) in the United States","volume":"15","author":"Ramjee","year":"2023","journal-title":"Clin. Outcomes Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e2239131","DOI":"10.1001\/jamanetworkopen.2022.39131","article-title":"Assessment of Spending for Patients Initiating Dialysis Care","volume":"5","author":"League","year":"2022","journal-title":"JAMA Netw. 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