Differing effects of Nefecon and Sparsentan in a patient with recurrent IgA nephropathy post-kidney transplantation

IgA nephropathy (IgAN) is a major cause of late graft loss after kidney transplantation, yet evidence for newly approved IgAN-specific therapies in this setting is scarce. We report a young male transplant recipient with biopsy-proven recurrent IgAN seven years after living-donor transplantation. Treatment with targeted-release budesonide (nefecon) was associated with a delayed and incomplete antiproteinuric response, clinically relevant systemic glucocorticoid-related adverse effects and progressive graft function decline. After discontinuation of nefecon, combined therapy with sparsentan and empagliflozin resulted in sustained albuminuria reduction, stabilization of graft function, improved blood pressure control, and resolution of metabolic complications. This case highlights challenges and opportunities in integrating novel IgAN therapies into post-transplant care.