Seek expert advice.
Supportive treatment, including administering angiotensin-receptor blockers (ARBs) and salt restriction, should be administered to all IgAN patients (1)
- importance of conservative therapy to reduce proteinuria and slow the rate of renal function decline in IgAN cannot be overemphasized (2)
A low protein diet is also advisable in nephrotic IgA nephropathy patients (1)
If recurrent chronic tonsillar infections then tonsillectomy is indicated.
Sparsentan is a dual endothelin angiotensin receptor antagonist is developed for the treatment of IgA nephropathy.
NICE state (3):
- sparsentan can be used as option to treat primary immunoglobulin A nephropathy (IgAN) in adults with a:
- urine protein excretion of 1.0 g/day or more, or
- urine protein-to-creatinine ratio (UPCR) of 0.75 g/g or more
The NICE committee noted "...clinical trial evidence shows that sparsentan reduces UPCR more than irbesartan. Evidence also suggests that sparsentan is better at maintaining kidney function than irbesartan, but this is uncertain.."
Use of immune-suppressive agents depends mainly upon the progression rate, comorbidities, and histopathological changes of the kidney biopsy (1):
- corticosteroids are currently the cornerstone of IgA nephropathy
- NICE have stated that
- Targeted-release budesonide is recommended as an option for treating primary immunoglobulin A nephropathy (IgAN) when there is a risk of rapid disease progression in adults with a urine protein-to-creatinine ratio of 1.5 g/g or more (4)
- it is an add-on to optimised standard care including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated
- different therapeutic agents such as calcineurin inhibitors (CNIs), cyclophosphamide, mycophenolate mofetil, rituximab, and leflunomide (LEF) are used, but none is approved as a single or combined effective therapy for IgA nephropathy
Reference:
- Habas E, Ali E, Farfar K, Errayes M, Alfitori J, Habas E, Ghazouani H, Akbar R, Khan F, Al Dab A, Elzouki AN. IgA nephropathy pathogenesis and therapy: Review & updates. Medicine (Baltimore). 2022 Dec 2;101(48):e31219.
- Rodrigues JC, Haas M, Reich HN. IgA Nephropathy. Clin J Am Soc Nephrol. 2017 Apr 3;12(4):677-686. doi: 10.2215/CJN.07420716.
- NICE (June 2025). Sparsentan for treating primary IgA nephropathy
- NICE (December 2023). Targeted-release budesonide for treating primary IgA nephropathy