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“Introduction More than 40 years have passed since immunoglobulin (Ig) A nephropathy was first described by Berger and Hinglais in 1968 [1]. Various approaches such as antiplatelet medication, fish oil, oral prednisolone, intravenous prednisolone, tonsillectomy, and tonsillectomy plus steroid pulse therapy (TSP), have been proposed for treating patients with adult IgA nephropathy. Clinicians often face challenges in deciding which treatment is most suitable for each patient, while balancing the hopes of patients AZD5582 concentration and their families with insufficient clinical evidence. Here we review the data from clinical trials and give a perspective on the treatment of IgA nephropathy. What is the treatment dilemma for Japanese

nephrologists? Are the annual urinary screening system (kenshin) and kidney biopsies useful? A Japanese law established a system of annual urinary screening (kenshin) in schools and workplaces approximately 40 years ago. About 40% of the Japanese population receive kenshin each year. Persons with detected urinary abnormalities are advised to consult local physicians. If a

local physician finds >1+ proteinuria on repeat urinary testing, he refers the patient to a nephrologist. Approximately 10,000 kidney biopsies are performed each year in Japan, of which 30–40% (3,000–4,000 persons) receive a diagnosis of IgA nephropathy. Many patients with IgA nephropathy are diagnosed at an early stage in Japan. The benefit of kenshin and kidney biopsies depends on whether early intervention can improve the prognosis of LY294002 IgA nephropathy. The Ministry of Health, Labour and Welfare of Japan requires the Japanese Society of Nephrology to demonstrate the efficacy of kenshin; however, Japanese nephrologists are not currently able to do so. The desire of patients and their families versus insufficient clinical evidence Since TSP was first reported by Hotta et al. in 2001 [2], a recent analysis revealed that 600 patients in Japan received TSP in 2006. More than one thousand patients received TSP in 2010. One year after TSP, 50% of patients achieved clinical remission (CR), defined as no urinary abnormalities [3]. Many patients and their families, having discovered information about the efficacy of TSP through the Internet or personal communications, visit the hospital to seek TSP.