Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV).
The KDIGO 2025 guideline update for IgA nephropathy and IgA vasculitis encourages a more liberal kidney biopsy policy, sets stricter proteinuria targets (< 0.5 g/d, ideally < 0.3 g/d), and introduces a dual treatment strategy that both reduces pathogenic IgA and manages the consequences of nephron loss.
Background
The IgA nephropathy (IgAN) and IgA vasculitis (IgAV) management guidance was last updated within the KDIGO 2021 glomerular diseases guideline. New developments in disease assessment and therapy prompted a major 2025 update, with this executive summary serving as a quick reference to the most important changes.
Key recommendations
The 2025 guideline encourages a more liberal kidney biopsy policy and aims for stricter proteinuria control, with a goal of less than 0.5 g/d and ideally less than 0.3 g/d alongside a stable eGFR. A central new concept is to combine therapies that prevent or reduce pathogenic IgA production and immune-complex formation with therapies that manage existing IgAN-induced nephron loss. Options for the first aim include targeted-release budesonide (Nefecon) or reduced-dose systemic corticosteroids, and mycophenolate mofetil in Chinese patients; the second aim relies on lifestyle measures, renin-angiotensin system blockade, SGLT2 inhibitors, and dual endothelin-angiotensin receptor blockers.
Clinical implications
Guidance for special situations such as nephrotic syndrome, acute kidney injury, rapidly progressive glomerulonephritis, pregnancy, and children with IgAN or IgAV changed little, reflecting a continued lack of major trials in these populations. Overall the update reframes IgAN management around earlier diagnosis, tighter proteinuria goals, and a two-pronged disease-modifying plus renoprotective treatment approach.
Category
KDIGO
Source
Kidney Int
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