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IgA Nephropathy — ESENeph MCQ

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HardGlomerulonephritisIgA NephropathyESENeph

A 35-year-old man presents with visible haematuria and proteinuria of 1.8 g/day. Kidney biopsy confirms IgA nephropathy with MEST-C M1 E1 S1 T1 C0. eGFR is 62 mL/min/1.73m2. He is started on Ramipril titrated to maximum dose and Dapagliflozin. After 6 months, proteinuria remains 1.2 g/day. According to KDIGO 2025 IgAN guidance, what is the most appropriate next step?

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Correct answer: B — Targeted-release Budesonide (Nefecon)

The KDIGO 2025 IgAN guideline introduces a dual treatment concept: manage IgA-IC formation (disease modification) and manage nephron loss (foundational CKD therapy). For patients at risk of progression with persistent proteinuria ≥0.5 g/day despite optimised RASi and SGLT2i, targeted-release budesonide (Nefecon) is recommended as a disease-modifying agent. The proteinuria target is now <0.5 g/day, ideally <0.3 g/day.

Reference: KDIGO 2025 – Clinical Practice Guideline for IgA Nephropathy and IgA Vasculitis