IgA Nephropathy Treatment: Complete Guide to Current Options
- Sean Hashmi, MD
- 4 hours ago
- 2 min read
IgA nephropathy treatment has changed dramatically since 2021—if you were diagnosed before then, the options your doctor discussed may already be outdated. Steroids are no longer your only choice, and newer targeted therapies are showing remarkable results in clinical trials.
Key Takeaways
SGLT2 inhibitors reduce kidney failure risk by 30-40%—even if you don't have diabetes
Sparsentan achieves 40% greater proteinuria reduction than ARBs alone
Nefecon targets the gut where faulty IgA is produced, with fewer steroid side effects
Overview
For years, IgA nephropathy treatment followed a predictable pattern: ACE inhibitors or ARBs to control blood pressure, and if you were high risk, systemic steroids like Prednisone. That approach had significant limitations—steroids work, but they come with serious side effects including weight gain, infections, bone loss, and diabetes risk.
The 2021 TESTING trial confirmed what many nephrologists suspected: while steroids reduce proteinuria, the rate of serious infections was alarmingly high. Patients were getting sick. Some were hospitalized. The question became: can we do better?
The answer is yes.
The New Treatment Landscape
Since 2021, we've seen a revolution in IgA nephropathy treatment. The 2021 KDIGO guidelines now recommend a tiered approach that starts with foundation therapies everyone needs, then adds targeted treatments for high-risk patients who don't respond adequately.
Tier 1 includes RAS inhibitors (ACE inhibitors or ARBs) at maximal tolerated doses, SGLT2 inhibitors regardless of diabetes status, and blood pressure control targeting less than 120/80. The DAPA-CKD trial showed SGLT2 inhibitors lower the risk of kidney failure by 30-40% in patients with chronic kidney disease—including those with IgA nephropathy.
Tier 2 introduces targeted therapies for patients who remain high-risk after optimizing Tier 1. Two game-changing options have emerged:
Nefecon (Budesonide) is a targeted-release steroid that dissolves in the small intestine, right where the faulty IgA is produced. The NefIgArd trial showed it preserves kidney function while avoiding many systemic steroid side effects.
Sparsentan (Filspari) is a dual blocker that's more potent than traditional ARBs alone. The PROTECT trial demonstrated 40% greater proteinuria reduction compared to Irbesartan—without immunosuppression.
What's Coming Next
The pipeline is full. Complement inhibitors like Iptacopan and Narsoplimab are targeting the inflammatory cascade that damages kidneys. B-cell targeted therapies aim to reduce production of faulty IgA at its source. Researchers are even exploring microbiome modulation, since IgA nephropathy starts in the gut.
What You Can Do
Ask your nephrologist if you're on an SGLT2 inhibitor—if not, find out why
Confirm you're on the maximal tolerated dose of your ACE inhibitor or ARB
If your proteinuria remains above 1 gram despite optimization, discuss Tier 2 options
The Bottom Line
IgA nephropathy treatment is no longer one-size-fits-all. The combination of foundation therapies and newer targeted options means more patients can preserve kidney function longer. If you haven't had a treatment conversation with your nephrologist since 2021, it's time for an update.
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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.