KDIGO 2025 Clinical Practice Guideline for the Management of IgA Nephropathy and IgA Vasculitis
The full KDIGO 2025 Clinical Practice Guideline for IgA nephropathy and IgA vasculitis updates the 2021 recommendations with a more liberal biopsy policy, stricter proteinuria goals, and a dual disease-modifying plus renoprotective treatment framework reflecting newly available targeted therapies.
Background
IgA nephropathy is the most common primary glomerulonephritis worldwide and an important cause of kidney failure in young adults. Following accelerating drug development since the KDIGO 2021 glomerular diseases guideline, KDIGO published a major 2025 update covering the diagnosis, prognosis, and treatment of IgAN and IgA vasculitis.
Key recommendations
The guideline now encourages a more liberal kidney biopsy policy and stricter proteinuria targets of less than 0.5 g/d and ideally less than 0.3 g/d with a stable eGFR. Treatment is organized around two aims: reducing pathogenic IgA production and immune-complex formation (using targeted-release budesonide or reduced-dose systemic corticosteroids, and mycophenolate mofetil in Chinese patients) and managing the consequences of nephron loss with healthy lifestyle measures, renin-angiotensin system blockade, SGLT2 inhibitors, and dual endothelin-angiotensin receptor blockade.
Clinical implications
Because several IgAN therapies received accelerated regulatory approval around the time of publication, KDIGO has signaled that further commentary and updates will be needed to position newer complement inhibitors and B-cell-modifying agents. For most special situations, including pediatric and pregnancy settings, recommendations remained largely unchanged given limited trial evidence.
Category
KDIGO
Source
KDIGO
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