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IgAN Treatment Threshold 0.5g Proteinuria — ESENeph MCQ

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EasyGlomerulonephritisIgAN Treatment Threshold 0.5g ProteinuriaESENeph

A 42-year-old woman with biopsy-proven IgA nephropathy and proteinuria 0.6 g/day on maximal RASi and Dapagliflozin has stable eGFR 62. She asks whether she should start Nefecon. According to KDIGO 2025, what proteinuria threshold triggers consideration of disease-modifying therapy?

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Correct answer: A — Proteinuria ≥0.5 g/day despite at least 90 days of optimised supportive/foundational care

KDIGO 2025 IgAN guideline sets the threshold for considering disease-modifying therapy at proteinuria ≥0.5 g/day despite at least 90 days of optimised supportive care (maximal RASi, SGLT2i, BP optimisation). At 0.6 g/day, this patient is above threshold. However, the decision should integrate the overall risk profile (KFRE, MEST-C scores, trajectory) and the potential benefits versus risks of the specific therapy. A shared decision-making approach is recommended.

Reference: KDIGO 2025 – IgA Nephropathy Guideline