In this issue we:
- Share helpful patient education resources and practical considerations for IgA nephropathy management
- Review how IgA nephropathy develops and progresses over time, and the importance of early diagnosis and intervention
- Explore the potential benefits of a dual-mechanism, kidney-targeted treatment strategy
IgA nephropathy is a rare, progressive kidney disease with a significant lifetime risk of kidney failure2,3
In IgA nephropathy, IgA immune complexes are deposited into the mesangium, leading to upregulation of endothelin-1 (ET-1) and angiotensin II (Ang II), two key disease mediators.4 Together, they drive ongoing kidney damage, resulting in proteinuria and glomerulosclerosis.4
Figure. Framing the underlying mechanism of IgA nephropathy for patient discussions5
Managing Proteinuria in IgA Nephropathy
Reducing proteinuria is key to protecting the kidneys in IgA nephropathy. This patient-friendly resource explains how to interpret this lab value.
Estimated glomerular filtration rate (eGFR) and proteinuria are measures of kidney function and failure3
Proteinuria is the only validated early biomarker to help guide clinical decision-making, and persistent proteinuria is the single strongest and modifiable prognostic indicator for IgA nephropathy disease progression.6-8
Although proteinuria levels below 1 g/day were traditionally considered “low risk”, data from the UK RaDaR registry show many of those patients with IgA nephropathy still progress to kidney failure.3 These findings reinforce the urgency of pursuing greater proteinuria reductions (<0.3 g/day) and early, kidney-targeted treatment.3,9
Long-Term Outcomes in IgA Nephropathy
Findings from RaDaR demonstrated that up to 30% of people previously considered low risk developed kidney failure within 10 years. Explore more findings from RaDaR with this patient-friendly Plain Language Summary.
Patient education may include information on the clinical significance of both eGFR and proteinuria3,8:
- Proteinuria is a marker of active kidney damage and an indicator for intervention
- eGFR represents a longer-term measure, indicating overall kidney function and trajectory
Figure. Patient-friendly explanation of proteinuria and eGFR levels8,10
The Relationship Between Proteinuria and IgA Nephropathy Disease Progression
The RaDaR study explored the impact of proteinuria on patients with IgA nephropathy. Learn more about key results with this patient resource.
Ensuring an early diagnosis, identifying at-risk patients, and implementing new treatment goals are essential to improve long‑term outcomes for patients8
Historically, standard of care (SOC) focused on supportive care, lifestyle management, rigorous blood pressure control with renin-angiotensin system inhibitors (RASi), and immunosuppression.11 However, SOC was often insufficient—this unmet need for many patients fueled a “renal renaissance” in IgA nephropathy treatment, leading to the approval of new therapies.12,13
Figure. Emerging trends in kidney disease management8
A dual endothelin angiotensin receptor antagonist (DEARA) represents a novel, non‑immunosuppressive approach to treating IgA nephropathy4
A DEARA inhibits two key pathways implicated in kidney damage in IgA nephropathy, ET-1 and Ang II.4,5,14 By targeting both pathways simultaneously, a DEARA helps reduce proteinuria and preserve kidney function over time without the need for immunosuppression.4,14
Management of IgA nephropathy has seen significant advancements over the last several years8,11,12
From a growing understanding of the disease to newly approved therapies, there is a drive to improve patient outcomes.3,12 IgA nephropathy is not the benign disease it was once thought to be, making patient awareness and education vital.3
Footnotes
- Gagliardi AR et al. BMC Med Inform Decis Mak. 2020;20(1):231.
- Mcgrogan A et al. Nephrol Dial Transplant. 2010;26(2):414-430.
- Pitcher D et al. Clin J Am Soc Nephrol. 2023;18(6):727-738.
- Kohan DE et al. Clin Sci (Lond). 2024;138(11):645-662.
- Lai KN et al. Nat Rev Dis Primers. 2016;2:16001.
- Inker LA et al. Am J Kidney Dis. 2016;68(3):392-401.
- Reich HN et al. J Am Soc Nephrol. 2007;18(12):3177-3183.
- KDIGO Clinical Practice Guidelines for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV). Accessed 22 October 2024. https://kdigo.org/wp-content/uploads/2024/08/KDIGO-2024-IgAN-IgAV-Guideline-Public-Review-Draft.pdf
- Floege J et al. Kidney International. 2025;107(4):640-651.
- Inker LA et al. Am J Kidney Dis. 2021;78(5):736-749.
- Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. Kidney Int. 2021;100(4S):S1-S276.
- FILSPARI® (sparsentan) Prescribing Information. San Diego, CA: Travere Therapeutics, Inc. 9/2024.
- Cheung CK and Barratt J. Semin Nephrol. 2024;44(5):151573.
- Trachtman H et al. Expert Rev Clin Immunol. 2024;20(6):571-576.
MA-DS-25-0049 | July 2025