IgA nephropathy: a paradigm shift in treatment strategies

PURPOSE OF REVIEW: This review will provide an overview of the current understanding of mechanisms which drive IgA nephropathy (IgAN), and explore new therapies (those approved or being evaluated in phase 3 studies) which modulate these mechanisms to improve outcomes. RECENT FINDINGS: IgAN remains the most reported primary glomerular disease worldwide. It is now clear that the majority of those diagnosed with IgAN are likely to progress to kidney failure over their lifetime, unless stringent disease control is achieved early. For decades, therapeutic options have been limited to interventions generic to chronic kidney disease (CKD), which could not alone rescue patients with IgAN from the risk of kidney failure. Recent advances in our understanding of the mechanisms driving IgAN, coupled with regulatory shifts in approvable clinical trial endpoints, have led to a surge in the development and evaluation of targeted therapies. SUMMARY: As of early 2025, four agents have already received regulatory approval, and many more are expected. New treatments act on IgAN-specific disease pathways and modify disease pathways generic to CKD. For the first time, it is now possible to initiate well tolerated, effective, truly disease-modifying interventions early to meaningfully reduce the lifetime risk of kidney failure among those living with IgAN.