Recent advances in the treatment of IgA nephropathy

Jürgen Floege, MD, is a professor of medicine, director of the Division of Nephrology and Clinical Immunology at the University Hospital RWTH Aachen, Germany, and Distinguished Fellow of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA).

Have there been significant advances in the treatment of IgA nephropathy in recent years?

Have there been any significant advances in the treatment of IgA nephropathy in recent years? Yes, there have, and it’s a wonderful time to work on IgA nephropathy, which is one of my key interests.

In the past the question was “What are the predictors of dialysis?” and “Should we use corticosteroid therapy, high-dose corticosteroids, or not?” which is still controversial in the year 2023.

The most important advances are that we have better supportive care and the value of supportive care is very recognized: optimize your renin-angiotensin system (RAS) blocker; give a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, which really protects the kidney; and we have learned about encapsulated, targeted-release formulation [of] budesonide, which may be a beautiful alternative to high-dose steroids and has much fewer side effects.

And there’s much more to come. Endothelin [receptor] antagonists, complement inhibitors—there are lots of trials. And B-lymphocyte proliferation inhibitors like a proliferation-inducing ligand (APRIL) or B-cell activating factor (BAFF). So, expect that the treatment of IgA nephropathy in 5 years from now will be totally different. The bad news is it will be costly, very, very costly. But that’s another issue.