A disease-modifying approach to the treatment of IgA nephropathy targeting mucosal IgA synthesis and beyond

The benefits and risks of systemic corticosteroids in the treatment of IgA nephropathy are still controversial. Part A results of the Efficacy and Safety of Nefecon in Patients With Primary IgA Nephropathy (NefIgArd) trial provide significant effects on decrease in proteinuria and protection from estimated glomerular filtration rate decline after 9 months of treatment with budesonide (Nefecon). Targeting the initiating pathogenetic event in the gut-associated lymphoid tissue would offer a disease-modifying approach to IgA nephropathy. Results, adverse events, and possible multiple effects of this treatment are critically discussed.