Discussion
hematuria, IgAN, proteinuria
HEMATURIA, ADVERSE EVENTS, DYSFUNCTION
In this trial, we found that fluticasone propionate combined with ACEI/ARB effectively decreased urinary protein level, but did not delay eGFR decrease in IgAN patients with biopsy-proven with mild to moderate proteinuria.It is known that macroscopic hematuria and/or increase of urinary protein occur in most IgAN patients after upper respiratory tract or alimentary tract infection, which implies that the development and progress of IgAN is closely related to immune system dysfunction [Fluticasone propionate has the function of anti-inflammation to inhibit inflammatory lymphocytes and inflammatory mediators they release, so that it could hinder inflammatory cells on the surface of the airway from being generated or activated [Compared with other similar glucocorticoids, fluticasone propionate is less absorbed from the gastrointestinal tract and has a significant liver first pass effect. After inhalation, the dose of fluticasone propionate into the circulatory system through swallowing is almost zero [There are several limitations of this study. The primary limitation was the size and duration of the trial. It was a small-sample and single-center trial with short follow-up. Additionally, no hard endpoint was met. A larger trial of longer duration may demonstrate differences in endpoint. Therefore, further studies are needed to see if fluticasone propionate aerosol is useful for improving long-term outcomes for IgAN patients. This study demonstrated that fluticasone propionate combined with ACEI/ARB can effectively lower urinary protein level in IgAN patients even if the eGFR decrease is not delayed, and no adverse events were observed, which suggests that fluticasone propionate may provide a new treatment option for IgAN patients.