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IgAN Response to Supportive Care — ESENeph MCQ

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ModerateGlomerulonephritisIgAN Response to Supportive CareESENeph

A 42-year-old man with IgA nephropathy has been on supportive care for 12 months. His eGFR is stable at 50 mL/min/1.73m2 and proteinuria has fallen from 1.8 g/day to 0.4 g/day on maximum Ramipril and Dapagliflozin. According to KDIGO 2025, what is the next step?

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Correct answer: D — Continue current supportive care – proteinuria is now below the treatment threshold

The patient has achieved the KDIGO 2025 proteinuria target (<0.5 g/day, ideally <0.3 g/day) with supportive/foundational therapy alone. There is no indication for escalation to immunosuppressive or disease-modifying therapy. Continued monitoring is essential as proteinuria may rise if therapy is interrupted. Nefecon and other disease-modifying agents are reserved for those with proteinuria persisting at ≥0.5 g/day despite optimised supportive care.

Reference: KDIGO 2025 – IgA Nephropathy Guideline