Atrasentan ETA Antagonist IgAN — ESENeph MCQ

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HardGlomerulonephritisAtrasentan ETA Antagonist IgANESENeph

A 45-year-old man with IgA nephropathy has eGFR 40 mL/min/1.73m2 and persistent proteinuria of 2 g/day despite maximal supportive care including SGLT2i. He is being considered for Atrasentan. What is Atrasentan's mechanism?

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Correct answer: D — Selective endothelin A receptor antagonist

Atrasentan is a selective endothelin A (ETA) receptor antagonist that reduces proteinuria by blocking endothelin-1-mediated glomerular injury (podocyte dysfunction, mesangial contraction, and fibrosis). The ALIGN trial in IgAN showed significant proteinuria reduction. Unlike Sparsentan (dual ETRA/ARB), Atrasentan selectively targets ETA. Fluid retention is a class effect of endothelin antagonists requiring monitoring. KDIGO 2025 IgAN guideline references endothelin receptor antagonists as emerging therapies for managing nephron loss.

Reference: KDIGO 2025 – IgAN Guideline; ALIGN Trial 2024