IgA Nephropathy in Adults: A Review

Area of Science:

• Nephrology
• Immunology
• Internal Medicine

Background:

• IgA nephropathy (IgAN) is the most common immune-mediated glomerular disease globally, affecting millions. It involves IgA immune complex deposition in the kidneys, leading to inflammation, scarring, and potential kidney failure.
• The disease often presents in younger adults with hematuria or proteinuria, with up to 50% progressing to kidney failure within a decade.
• Diagnosis typically involves ruling out other conditions and confirming IgA deposits via kidney biopsy, especially in adults with significant proteinuria.

Purpose of the Study:

• To outline the diagnostic criteria and current management strategies for IgA nephropathy (IgAN) based on the latest clinical practice guidelines.
• To emphasize the importance of early diagnosis and comprehensive treatment approaches to slow disease progression and prevent kidney failure.

Main Methods:

• Review of diagnostic workup for suspected IgAN, including urinalysis, proteinuria quantification, and kidney biopsy.
• Analysis of treatment recommendations from the Kidney Disease: Improving Global Outcomes (KDIGO) 2025 guideline for IgAN management.
• Identification of key therapeutic targets, including behavioral modifications, blood pressure control, and novel pharmacological interventions.

Main Results:

• Kidney biopsy is crucial for diagnosing IgAN in adults with proteinuria ≥0.5 g/day.
• Effective management includes lifestyle adjustments (diet, smoking cessation, weight control), antihypertensive therapy targeting <120/70 mm Hg, and specific medications.
• Therapeutic options aim to reduce IgA immune complex formation (e.g., targeted-release budesonide), decrease glomerular injury (e.g., glucocorticoids, iptacopan), and manage nephron loss (e.g., RAS inhibitors, dual endothelin angiotensin receptor antagonists, SGLT2 inhibitors).

Conclusions:

• IgA nephropathy requires prompt diagnosis and multifaceted treatment strategies.
• Current guidelines recommend a combination of conservative measures and targeted therapies to manage IgAN and preserve kidney function.
• Ongoing research and guideline updates focus on novel agents to combat this prevalent kidney disease.