Advances in Therapy to Address Proteinuria in Patients with Immunoglobulin A Nephropathy

As the majority of patients with IgA nephropathy (IgAN) progress to kidney function loss, it is important to treat this primary glomerulonephritis in a way that will prevent or slow such progression. In a presentation delivered at the 2024 Nephro Update Europe congress, Jörg Latus, from Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany, discussed the relevance of assessing proteinuria levels in patients with IgAN and how this is recognised in the 2024 Kidney Disease Improving Global Outcome (KDIGO) guidelines, currently in draft form. Since the 2021 KDIGO guidelines, therapy choices for IgAN advances have widened and include those specifically developed for IgAN, such as the dual endothelin and angiotensin II receptor antagonist sparsentan and modified-release budesonide (MRB), as well as sodium-glucose cotransporter-2 inhibitors (SGLT2i), which have a broader role in chronic kidney disease treatment. Latus discussed some of the pivotal trials that led to these medications being approved for use in patients with IgAN, along with real-world data for sparsentan. Also discussed were trials for other IgAN pathogenesis-targeting medications, future approval of which is hoped to open the choice of treatments for patients with IgAN at risk of progressive kidney function loss such that more individualised therapy regimens can be provided.