Management of IgA nephropathy (IgAN) is moving beyond supportive care alone toward a more targeted, risk-based approach. Blood pressure control, renin-angiotensin system blockade, lifestyle modification, SGLT2 inhibitors, and close monitoring of proteinuria and eGFR remain foundational. Newer therapies increasingly target disease-specific mechanisms such as endothelin signaling, mucosal immune activation, complement pathways, and B-cell/plasma-cell activity. Corticosteroids may still have a role in selected higher-risk patients, but their potential renal benefits must be weighed against risks such as serious infection, metabolic complications, and other treatment-related toxicities.
The expanding treatment landscape makes risk stratification and longitudinal monitoring increasingly important. Persistent proteinuria, declining eGFR, hypertension, and adverse histologic features remain key indicators of progression risk, while newer targeted therapies may offer additional options for patients who remain at risk despite optimized supportive care. However, important uncertainties remain, including the lack of direct head-to-head trials, limited long-term safety and kidney-outcome data, cost and access barriers, and uncertainty around the best sequencing or combination of therapies. These gaps reinforce the need to individualize treatment decisions and monitor both kidney function and proteinuria over time as the IgAN treatment paradigm continues to evolve.
Reference: Alroshodi A. Recent Advances in the Management of IgA Nephropathy: From Supportive Care to Targeted Therapies. Cureus. 2026 Jun 21;18(6):e111227. doi: 10.7759/cureus.111227.
Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC13301135/
