Immunoglobulin A nephropathy (IgAN) represents the predominant glomerulonephritis globally and is a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Historically, supportive management, with blood pressure control, renal angiotensin system (RAS) blockade, and active management with steroids, has been tried. However, the treatment landscape has recently become more complex with the introduction of several highly specific therapies. This review aims to provide an in-depth overview of the latest developments in IgAN management, including traditional supportive care and exposure to novel and specific treatments. The review highlights the morbidity of IgAN, its risk of progression to ESRD, and the importance of supportive care. New supportive treatments, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors and sparsentan, demonstrate renal protective effects. As for active management, corticosteroids remain effective but are constrained by their side effects. New specific agents, such as budesonide, complement inhibitors, and immune modulators, are showing potential effectiveness in improving proteinuria and preserving renal function. Nonetheless, it faces certain challenges, including a lack of head-to-head trials, limited long-term efficacy and safety data, and affordability issues. The development of IgAN management has considerable potential, although additional research and the implementation of these findings are crucial to optimizing outcomes for patients worldwide.
Abdulaziz Alroshodi (Sun,) studied this question.