Integrated Traditional Chinese and Western Medicine for Immunoglobulin A Nephropathy: Recent Advances and Future Directions.

Abstract

IgAN is the most common primary glomerular disease worldwide. It is characterized by high heterogeneity and poor long-term prognosis. Integrated traditional Chinese medicine and Western medicine (TCM-WM) has become a distinct and effective strategy for the treatment of IgAN in China. This review summarizes recent evidence-based research into integrated TCM-WM in IgAN management and its contribution to our understanding of IgAN etiology, current clinical practices, and the therapeutic mechanisms of TCM-WM treatments. Western explanations for IgAN pathogenesis center on aberrant IgA1 glycosylation, mucosal immune abnormalities, and inflammatory injury. These correspond to the traditional Chinese medicine (TCM) explanation of wind pathogen invading the kidney, inducing deficiency, stasis, and toxicity. Integrated TCM-WM management follows a staged approach to syndrome differentiation, and interventions aim to regulate the immune response, modulate the gut-kidney axis, and reduce inflammation and fibrosis. High-quality clinical evidence supports the efficacy and safety of several representative Chinese medicines. Based on long-term research, we have established a combined TCM five-syndrome typing and Western medicine five-stage pathologic blockade framework and propose an integrated five-sphere disease-syndrome-symptom-stage-biological characterization model. Supported by multiomics and artificial intelligence, this model bridges TCM syndromes and molecular pathologic mechanisms and facilitates precision therapy. Integrated TCM-WM effectively improves clinical remission and delays disease progression in IgAN. Future studies should focus on further biological integration of TCM syndrome dynamics and core molecular mechanisms to establish standardized precision protocols that promote the global application of integrated TCM-WM in IgAN management.