Treatment of patients with IgA nephropathy: a call for a new paradigm.
This review argues that IgA nephropathy should be managed as both a chronic kidney disease and an immunological disease, combining therapies with different mechanisms of action rather than relying on supportive care alone.
Background
IgA nephropathy is the world's most common primary glomerular disease and carries a substantial lifetime risk of kidney failure. For years, management focused largely on supportive care, including renin-angiotensin system blockade, blood pressure control, and lifestyle modification, while the role of high-dose corticosteroids remained variable and was associated with serious adverse effects.
Key recommendations
The authors propose a new treatment paradigm that targets the immune components and the chronic kidney disease components of IgA nephropathy in parallel by combining therapies with different mechanisms of action. They highlight that regulatory acceptance of changes in proteinuria and estimated glomerular filtration rate slope over 2 to 3 years as surrogate endpoints has accelerated drug development. Several agents have been approved, including SGLT2 inhibitors, sparsentan (a dual endothelin and angiotensin II receptor antagonist), nefecon (a targeted-release budesonide), and iptacopan (a complement factor B inhibitor).
Clinical implications
A combined, mechanism-based strategy aims to preserve long-term kidney survival rather than relying on a single agent. With more therapies expected in the coming years, the review frames treatment around addressing both pathogenic IgA-driven immune injury and generic chronic kidney disease progression to reduce the lifetime risk of kidney failure.
Category
Research
Source
Kidney Int
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