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IgA Nephropathy Treatment: 5 Steps to Protect Your Kidneys


Every IgA Nephropathy patient asks the same question: What do I do right now to stop my kidneys from failing? After years of treating IgA Nephropathy patients, I've developed a 5-step action plan based on the latest KDIGO guidelines and clinical trial evidence. This is the exact roadmap I give patients in my clinical practice — and it works.


Key Takeaways

  • Track three numbers religiously: proteinuria (target <0.5 g/day), eGFR (stable slope), and blood pressure (<120/80)

  • Most IgA Nephropathy patients are undertreated — SGLT2 inhibitors reduce kidney failure risk by 30-40% but many patients still aren't on one

  • If proteinuria remains above 1 g/day after 3-6 months of optimized foundation therapy, newer targeted treatments like Nefecon or Sparsentan may help


Overview

Step 1: Know Your Numbers

Managing IgA Nephropathy starts with understanding your labs — not just getting them done, but tracking trends over time. The three critical numbers are:


Proteinuria (albumin-to-creatinine ratio or total protein-to-creatinine ratio): Target less than 0.5 grams per day. This is your most important marker of disease activity.


eGFR (kidney function): The goal is a stable slope — not declining rapidly year after year.


Blood pressure: Target less than 120/80 mmHg consistently.


Create a simple tracking system using a spreadsheet, notebook, or your health system's patient portal. Log these numbers every 3-6 months. Use the IgA Nephropathy Prediction Tool (qxmd.com/calculate/calculator_499) to calculate your 5-year kidney failure risk each time you get new labs. When your risk trends down, you're winning. When it stays high, it's time to escalate treatment.


Step 2: Maximize Your Foundation

Most IgA Nephropathy patients are undertreated — not because their doctors are bad, but because medications aren't pushed to optimal dosages.


ACE inhibitors or ARBs should be titrated to the maximum tolerated dose. Many patients remain on low doses (like lisinopril 10mg) when they could tolerate 20mg or 40mg. You've reached your maximum tolerated dose when you experience dizziness from low blood pressure, develop a dry cough (ACE inhibitor side effect), or your potassium rises too high.


SGLT2 inhibitors are non-negotiable per the 2021 KDIGO guidelines. The DAPA-CKD trial demonstrated a 30-40% reduction in kidney failure risk — regardless of diabetes status. If you're not on one, ask your doctor why. Common barriers like cost can often be addressed through manufacturer patient assistance programs.


Blood pressure control requires daily home monitoring. If your RAS inhibitor alone isn't achieving targets, additional medications like calcium channel blockers or diuretics may be needed.


Step 3: Consider Targeted Therapies

After 3-6 months of optimized foundation therapy, if proteinuria remains above 1 gram per day with high-risk features, two newer options exist:


Nefecon (Budesonide/Tarpeyo) targets the gut where IgA Nephropathy originates. The NefIgArd trial showed a 5 mL/min/1.73m² better preservation of kidney function over two years with significant proteinuria reduction. It's approved for patients with proteinuria greater than 1 g/day and eGFR above 35 mL/min, used for 9 months.


Sparsentan (Filspari) is a dual angiotensin and endothelin blocker more potent than ARBs alone. The PROTECT trial demonstrated 40% greater proteinuria reduction at 110 weeks compared to irbesartan. It replaces your ACE inhibitor or ARB and is approved for patients with proteinuria above 1 g/day and eGFR above 30 mL/min.


Step 4: Live a Kidney-Friendly Lifestyle

Medications are only half the battle. Four lifestyle pillars matter most:


Sodium control (less than 2 grams daily) is the most important dietary change. Cook at home, read labels (aim for less than 140mg per serving), and use herbs instead of salt. The 80/20 rule applies — be strict 80% of the time.


Protein moderation targets 0.8 grams per kilogram of body weight daily, preferably from plant-based sources. For a 154-pound person, that's approximately 56 grams of protein per day.


Plant-predominant eating follows the kidney-friendly plate: 50% non-starchy vegetables, 25% lean proteins, 25% whole grains. The DASH, Mediterranean, or whole-food plant-based diets all work well.


Harm reduction means never taking NSAIDs (ibuprofen, naproxen) and quitting smoking — smokers progress to kidney failure 2-3 times faster.


Step 5: Monitor Regularly

Consistency determines outcomes. If your numbers are stable, see your nephrologist every 6 months with labs at the same interval. If you're higher risk (proteinuria above 1 g/day or declining eGFR), increase visits to every 3 months with more frequent labs and daily home blood pressure checks.


After starting any new medication, get labs done around 4 weeks to check kidney function and potassium levels. If you experience a flare (blood in urine after infection), contact your nephrologist immediately.


What You Can Do

  • Start tracking today: Create a simple log of your proteinuria, eGFR, and blood pressure. Calculate your 5-year risk using the IgA Nephropathy Prediction Tool.

  • Audit your medications: Ask your nephrologist if you're on maximum tolerated doses of your ACE inhibitor or ARB, and whether you're a candidate for an SGLT2 inhibitor.

  • Cut sodium this week: Start reading labels and aim for less than 2 grams daily. Cook one more meal at home than usual.

  • Schedule your next appointment: If you haven't seen your nephrologist in over 6 months, book a follow-up now.

  • Join a support community: Connect with the IgA Nephropathy Foundation, NephCure Kidney International, or online communities like r/kidneydisease.


The Bottom Line

You are not a victim of IgA Nephropathy — you are the CEO of your kidney health. Patients who take control early, track their numbers religiously, advocate for themselves with their doctors, and implement every step of this action plan are the ones who stabilize. IgA Nephropathy is manageable. You have the science, you have an action plan, and you are not alone.


Scientific References

  1. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. (2021). KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney International, 100(4S), S1-S276.

  2. Heerspink, H. J. L., et al. (2020). Dapagliflozin in patients with chronic kidney disease. New England Journal of Medicine, 383(15), 1436-1446. https://doi.org/10.1056/NEJMoa2024816

  3. Barratt, J., et al. (2023). Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial. Kidney International, 103(2), 391-402.

  4. Rovin, B. H., et al. (2023). Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial. The Lancet, 402(10417), 2077-2090.

  5. Barbour, S. J., et al. (2019). The MEST-C score and the international IgA nephropathy prediction tool. Seminars in Nephrology, 39(5), 411-419.


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Medical Disclaimer

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult your healthcare provider before making changes to your health routine. The views expressed are Dr. Hashmi's personal professional opinions and do not represent any employer or affiliated organization.


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