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IgAN Dual Treatment Framework — ESENeph MCQ

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ModerateGlomerulonephritisIgAN Dual Treatment FrameworkESENeph

A 38-year-old man with CKD G2A3 from IgA nephropathy has proteinuria of 3.5 g/day and eGFR 85 mL/min/1.73m2. He has been on maximal Ramipril and Dapagliflozin for 6 months. The KDIGO 2025 guideline introduces a dual treatment concept. What are the two treatment arms?

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Correct answer: E — (i) Therapies targeting pathogenic IgA immune complex formation (disease modification) AND (ii) therapies managing consequences of IgAN-induced nephron loss (foundational CKD therapy)

KDIGO 2025 IgAN guideline introduces a paradigm-shifting dual treatment framework: (1) disease-modifying therapies targeting the immunological root cause (pathogenic IgA production and immune complex formation) – including Nefecon, systemic glucocorticoids, and potentially complement inhibitors; and (2) foundational therapies managing the CKD consequences of nephron loss – including RASi, SGLT2i, Sparsentan, BP optimisation, and lifestyle modification. Both arms should be addressed simultaneously.

Reference: KDIGO 2025 – IgA Nephropathy Guideline