Immunosuppressive treatment of IgA nephropathy (IgAN) has been a controversial issue since many years, mainly because of skepticism on awaited results and fear of possible side effects. Some authors proposed the existence of a ‘point of no return’, after which the worsening in renal function becomes inexorable and treatment ineffective. Indeed, the decision to treat these patients is easily followed by disappointment due to lack of favorable results. We report the case of a 24-year-old woman with a diagnosis of IgAN with advanced sclerosis and chronic renal failure. After treatment with a 6-month steroid course, she experienced a long-lasting stabilization of renal function (serum creatinine) and decrease in proteinuria (from 2.9 to 0.46 g/24 h) that still persisted at the end of follow-up (48 months). Analysis of this case and review of the literature suggest that immunosuppressive treatment could delay the beginning of renal replacement therapy in the advanced phase of IgAN. However, the results of long-term, randomized, controlled, adequately sized trials are awaited.

1.
D’Amico G: Natural history of idiopathic IgA nephropathy: Role of clinical and histological prognostic factors. Am J Kidney Dis 2000;36:227–237.
2.
D’Amico G, Ragni A, Gandini E, Fellin G: Typical and atypical natural history of IgA nephropathy in adult patients. Contrib Nephrol. Basel, Karger, 1993, vol 104, pp 6–13.
3.
Scholl U, Wastl U, Risler T, Braun N, Grabensee B, Heering P, Schollmeyer P, Zauner I, Stein G, Funfstuck R, Keller F: The ‘point of no return’ and the rate of progression in the natural history of IgA nephritis. Clin Nephrol 1999;52:285–292.
4.
Pozzi C, Bolasco PG, Fogazzi GB, Rustichelli R, Altieri P, Ponticelli C, Locatelli F: Randomized trial of steroids in IgA nephropathy with moderate proteinuria at 5 years of follow up (abstract). EDTA, 1997.
5.
Pozzi C, Bolasco PG, Fogazzi GB, Andrulli S, Altieri P, Ponticelli C, Locatelli F: Corticosteroids in IgA nephropathy: A randomized trial. Lancet 1999;353:883–887.
6.
Goumenos D, Ahuja M, Shortland JR, Brown CB: Can immunosuppressive drugs slow the progression of IgA nephropathy? Nephrol Dial Transplant 1995;10:1173–1181.
7.
Tsuruya K, Harada A, Hirakata H, Mitsuiki K, Johko T, Kondoh H, Takechi S, Fujishima M: Combined therapy using prednisolone and cyclophosphamide slows the progression of moderately advanced IgA nephropathy. Clin Nephrol 2000;53:1–9.
8.
Locatelli F, Pozzi C, Del Vecchio L, Andrulli S, Pani A, Fogazzi GB, Altieri P, Ponticelli C: The role of combined treatment with steroids and azathioprine in IgA nephropathy: Design of a prospective randomized multi-center trial. J Nephrol 1999;12:308–311.
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