New immunosuppressive agents in chronic progressive glomerulopathies: an update

The etiology of chronic glomerulopathies is not yet clear, however the impairment of immune system is supposed to play a decisive role. Thus, immunosuppressants are often used to slow the activity and/or progression of the disease. Usually the patients are treated either by corticosteroids alone or by the combination of corticosteroids with other immunosuppressive agents. Recently, immunosuppressants successfully applied in the transplantation medicine have been also tested in the therapy of chronic glomerulopathies. Cyclosporine A, a potent calcineurin inhibitor, has been used as a second line therapy. The place of CsA in lupus nephritis and especially in IgA nephropathy is not defined so well as it is in idiopathic nephrotic syndrome. The newer calcineurin inhibitor tacrolimus is already widely used in the transplantation medicine while its effectiveness in clinical nephrology has to be tested. Mycophenolate mofetil in monotherapy or with concomitant low-dose steroids can be regarded as an alternative therapeutical approach in case of standard regimens' failure. Sirolimus just entered clinical transplant medicine and its role in slowing the progression of chronic glomerulopathies is not yet clear.