Treatment Options for Mild IgA Nephropathy with Lee Grade II: A Comprehensive Guide

IgA nephropathy, also known as Berger's disease, is one of the most common forms of primary glomerulonephritis worldwide. When diagnosed at an early stage—particularly with a Lee pathology classification of Grade II—the condition indicates mild structural damage, offering a favorable long-term prognosis. In Lee Grade II, histological findings show that less than 25% of glomeruli are affected, with minimal tubular or interstitial injury. This early detection provides a critical window for effective intervention and disease management.

Understanding Lee Pathology Grading in IgA Nephropathy

The Lee grading system is a widely used histopathological classification based on kidney biopsy results. It helps clinicians assess the severity of kidney tissue damage and guide treatment decisions. Grade II represents mild to moderate changes, including segmental glomerular lesions such as mesangial proliferation and occasional crescent formation, but without widespread scarring or global sclerosis. Because the damage is limited, patients at this stage often maintain normal or near-normal kidney function.

Core Treatment Strategies for Mild IgA Nephropathy

Management of Lee Grade II IgA nephropathy focuses on slowing disease progression, reducing proteinuria, and preserving renal function. The cornerstone of therapy includes:

1. Blood Pressure and Proteinuria Control with ACEIs or ARBs

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are first-line medications. These drugs not only help control hypertension—a major risk factor for kidney deterioration—but also reduce protein excretion in the urine. By lowering intraglomerular pressure, they provide protective effects on the glomerular filtration barrier. Commonly prescribed examples include lisinopril, ramipril, losartan, and valsartan.

2. Adjunctive Use of Traditional Chinese Medicine (TCM)-Derived Supplements

In some clinical settings, especially in integrative or complementary medicine approaches, certain TCM-based formulations are used to support kidney health. Products like Bailing Capsules (containing Cordyceps sinensis extract) and Nephritis Recovery Tablets may help reduce proteinuria and modulate immune activity. While more large-scale Western studies are needed, existing evidence suggests potential benefits in improving urinary markers and overall well-being when used alongside conventional treatments.

3. Immunosuppressive Therapy Considerations

For patients exhibiting persistent heavy proteinuria (typically >1 g/day) despite optimal supportive care, immunosuppressive agents may be considered. Options can include corticosteroids like prednisone or other immunomodulators, depending on individual risk-benefit assessments. However, due to potential side effects, such therapies are carefully evaluated and typically reserved for cases showing progressive signs rather than routine use in mild Grade II disease.

Lifestyle and Long-Term Monitoring

Beyond medication, lifestyle modifications play a crucial role. Patients are encouraged to adopt a kidney-friendly diet—low in sodium, moderate in protein—and maintain healthy hydration. Regular monitoring of blood pressure, urine protein levels, and serum creatinine is essential to track disease stability. Routine follow-ups with a nephrologist ensure timely adjustments in therapy if needed.

With appropriate management, individuals with mild IgA nephropathy (Lee Grade II) often experience slow or even halted disease progression. Early diagnosis, combined with a personalized, multidisciplinary approach, significantly improves long-term outcomes and quality of life.