Kidney Week 2025 Early Program - Glomerular Diseases: 2025 Update-Choosing the Right Drug Regimen Among Many New Options for IgA Nephropathy Treatment

Video Transcription

Video Summary

Dr. Richard Lafayette discusses how to choose among rapidly expanding treatment options for IgA nephropathy (IgAN). He presents a typical case (young woman, ~1 g/day proteinuria, preserved GFR, active biopsy lesions) to emphasize that “watchful waiting” alone is no longer appropriate when risk features exist. IgAN is heterogeneous: some patients with low-grade proteinuria have excellent long-term outcomes, while others progress to kidney failure. Proteinuria reduction (ideally <500 mg/day, preferably <300 mg/day) and stabilizing GFR are key treatment goals.<br /><br />Historically, care relied on lifestyle measures and renin–angiotensin system (RAS) blockade, with inconsistent benefits and substantial toxicity from systemic steroids. Now multiple effective options exist: SGLT2 inhibitors, endothelin receptor antagonists (including dual angiotensin/endothelin agents like sparsentan), targeted-release budesonide (Nefecon), and complement inhibitors (e.g., iptacopan). Emerging therapies targeting B-cell/plasma-cell pathways (APRIL/BAFF agents such as atacicept and sibeprenlimab) show strong biomarker effects and promising GFR stabilization.<br /><br />A key practical message: trial data suggest many agents reduce proteinuria across subgroups (early/late disease, different biopsy patterns), so selection is not yet biomarker-driven. Start with proven supportive therapy, reassess quickly, add/switch treatments to reach goals, and individualize based on safety, tolerability, cost, and patient preference.

Asset Subtitle

Richard Lafayette

Meta Tag

Module GLOM

Speaker Richard Lafayette

Keywords

IgA nephropathy

proteinuria reduction

supportive therapy

SGLT2 inhibitors

endothelin receptor antagonists

targeted-release budesonide

complement inhibitors

APRIL/BAFF pathway therapies