IgAN Triple Pathway KDIGO 2025 Approach — ESENeph MCQ

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HardGlomerulonephritisIgAN Triple Pathway KDIGO 2025 ApproachESENeph

A 36-year-old man is diagnosed with IgA nephropathy with MEST-C scores M1 E1 S1 T0 C0. His eGFR is 65 mL/min/1.73m2 and uPCR is 200 mg/mmol despite 3 months of maximal RASi. According to the KDIGO 2025 IgAN guideline treatment pathway, what combination approach is recommended?

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Correct answer: C — Combined haemodynamic and immunomodulatory treatment

KDIGO 2025 IgAN guidelines recommend a pathway-directed approach combining THREE therapeutic strategies simultaneously for patients at risk of progressive kidney function loss: (1) reducing glomerular hyperfiltration (maximised RASi or sparsentan PLUS SGLT2i), (2) reducing immune complex-mediated injury (Nefecon 9-month course, or systemic glucocorticoids if Nefecon unavailable), and (3) lifestyle measures and cardiovascular risk reduction. This represents a paradigm shift from the previous sequential approach. The E1 score suggests potential benefit from immunosuppression. The combination targets both the downstream consequences (proteinuria/fibrosis) and upstream immunological drivers of disease simultaneously.

Reference: KDIGO 2025 – IgAN/IgAV Guideline; ERA 2025 – IgAN Working Group Commentary: https://kdigo.org/guidelines/gd/