bThe domestically approved maximum dose of antihypertensive agents (mg)/US JNC7 recommendation dose: amlodipine (10/10), enalapril (10/40), olmesartan (40/40), captopril (150/100), candesartan (12/32), temocapril (4/–), trandolapril (2/4), valsartan (160/320), benazepril (10/40), verapamil (360/360), tamipril (–/10), losartan (100/100), conly when the number of required MK-8776 ic50 cases is calculated 1. Adult IgAN with urine

protein ≥1.00 g/day and (CKD) stage G1–2 First-line therapy: RASinhibitors and/or steroid therapy. Second-line therapy: Immunosuppressive agents, antiplatelet agents, tonsillectomy (+steroid pulse therapy), fish oil, etc.   2. Adult IgAN with urine protein ≥1.00 g/day and CKD stage G3 First-line therapy: RAS inhibitors. Second-line therapy: Steroid selleck chemical therapy, immunosuppressive agents, antiplatelet agents, tonsillectomy (+ steroid GF120918 clinical trial pulse therapy), fish oil, etc.   3. Adult IgAN with urine protein 0.50–0.99 g/day and CKD stage G1–3. Intervention should be considered because urine protein of 0.50–0.99 g/day has been reported to be a possible risk factor related to poor renal prognosis and urine protein should not be allowed to increase to ≥1.00 g/day, which is clearly a risk factor for unfavorable renal prognosis.   4. Adult IgAN with urine protein <0.50 g/day and CKD stage G1–2. Renal function outcome in IgAN with urine protein of

<0.50 g/day and CKD stage G1–3 is predicted to be favorable.   5. Adult IgAN with urine protein <1.00 g/day and CKD stage G3 or G4–5. Treatment interventions in accordance with the evidence-based CKD guideline 2013 are appropriate (Fig. 4). Fig. 4 An outline of treatment of IgAN in adults: focused on prevention of renal dysfunction (based on randomized controlled trials for IgAN). Choice of treatment should be carefully considered based on renal function, the amount of proteinuria, pathological findings, age, and other clinical findings.

Others: tonsillectomy (combined with high-dose pulse corticosteroid therapy), immunosuppressive agents, antiplatelet agents, and n-3 fatty acids (fish oil)   Are antiplatelet agents and anticoagulants recommended for decreasing urinary protein and preserving renal function in patients with IgAN? In the 1980s, a multi-center, randomized, double-blinded Methocarbamol controlled trial with dipyridamole and dilazep hydrochloride for chronic glomerulonephritis, including IgAN, was conducted in Japan. This study showed that anti-platelet agents were effective in reducing urine protein levels. However, since the report was not published in an English-language journal, it did not draw international attention. Systematic reviews evaluating the effect of dipyridamole and dilazep hydrochloride in slowing the progression of renal dysfunction and decreasing urine protein in IgAN have not been able to produce solid conclusions, since there are too few randomized parallel-group trials.