Nefecon Addition Sparsentan IgAN KDIGO 2025 — ESENeph MCQ

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ModerateGlomerulonephritisNefecon Addition Sparsentan IgAN KDIGO 2025ESENeph

A 65-year-old man with IgA nephropathy has been on sparsentan for 6 months. His liver function tests and BP are stable. He has persistent proteinuria (uPCR 110 mg/mmol) despite good adherence. According to KDIGO 2025, what additional disease-modifying therapy should be considered?

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Correct answer: A — Nefecon (targeted-release budesonide) for 9 months

KDIGO 2025 IgAN guidelines recommend a pathway-directed approach combining anti-proteinuric/anti-fibrotic therapy (RASi or sparsentan ± SGLT2i) with immunomodulation when proteinuria remains above target despite maximal supportive care. Nefecon (targeted-release budesonide) is recommended as a 9-month course (2B recommendation) for patients at risk of progressive kidney function loss. It targets the gut mucosal immune system (Peyer's patches) where aberrant IgA1 production originates, with a favourable systemic glucocorticoid side-effect profile compared to conventional steroids. The NefIgArd trial demonstrated sustained proteinuria reduction and eGFR preservation. Sparsentan and Nefecon can be used in combination.

Reference: KDIGO 2025 – IgAN/IgAV Guideline; Barratt et al 2023 – NefIgArd Trial