Selecting Treatment for IgA Nephropathy

Abstract

As an IgA nephropathy patient who was on a highdose steroid regimen for 9 months in 2021, I wanted to share my thoughts about the study titled "Immunosuppression versus Supportive Care on Kidney Outcomes in IgA Nephropathy in the Real-World Setting," published in this issue of CJASN. 1 The authors conclude that "Immunosuppressive therapy, compared with supportive care, was associated with a 40% lower risk of clinically important kidney outcomes in patients with IgA nephropathy." 1 I applaud the effort made by the authors to assess glucocorticoid treatment in patients with IgA nephropathy with eGFRs below 50 ml/ min per 1.73 m 2 . Patients newly diagnosed with eGFRs at this low level could greatly benefit from continued research that is very specific to treating IgA nephropathy that has already reduced kidney function so drastically.

An Update on Current Therapeutic Options in IgA Nephropathy

“…Although studies have reported the short-term efficacy of steroid therapy in patients at high risk of progressive disease, systemic glucocorticoid therapy has also been shown to be associated with significant adverse events in all trials alongside significant patient-reported intolerability [34]. Currently, the 2021 KDIGO Clinical Practice Guideline suggests that patients at high risk of progressive loss of kidney function are first offered the opportunity of enrolment in a clinical trial.…”