Reassessing finerenone's role in IgA nephropathy: methodological and clinical considerations

This letter addresses the study "Effectiveness and Safety of Finerenone in the Treatment of IgA Nephropathy Patients" by Qingqing Gao, which investigates finerenone as adjunct therapy in IgA nephropathy. While the study offers promising insights, key methodological limitations-including lack of randomization, blinding, and small sample size-raise concerns regarding selection bias and external validity. Additionally, the omission of important clinical parameters such as blood pressure and inflammatory markers limits the scope of safety monitoring. The letter emphasizes the need for larger, multicenter, randomized controlled trials with improved monitoring strategies, including MEST-C scoring, to enhance diagnostic accuracy and outcome interpretation. Despite the study's strengths in reporting UACR reduction and stable eGFR, a more rigorous research design is essential to fully evaluate finerenone's long-term efficacy and safety in this patient population.