Sparsentan First-Line IgAN KDIGO 2025 — ESENeph MCQ

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HardGlomerulonephritisSparsentan First-Line IgAN KDIGO 2025ESENeph

A 44-year-old man with biopsy-proven IgA nephropathy has been on maximum-dose losartan for 6 months. His eGFR is 55 mL/min/1.73m2 and uPCR remains 120 mg/mmol. BP is 118/72 mmHg. According to KDIGO 2025 IgAN guidelines, which therapeutic approach is recommended as an alternative first-line to RASi monotherapy?

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Correct answer: B — Sparsentan

KDIGO 2025 IgAN guidelines position sparsentan as an alternative first-line therapy to RASi. Sparsentan is a dual endothelin angiotensin receptor antagonist (DEARA) that should NOT be combined with RASi as it already incorporates ARB activity. The PROTECT trial demonstrated 49.8% proteinuria reduction with sparsentan vs 15% with irbesartan. If sparsentan is used, losartan should be stopped. SGLT2i can be added to either RASi or sparsentan. MMF, cyclophosphamide, tonsillectomy, and fish oil are not recommended as first-line disease-modifying therapy in primary IgAN.

Reference: KDIGO 2025 – IgAN/IgAV Guideline; Rovin et al 2023 – PROTECT Trial