#2-30E. KDIGO 2025: Navigating the Dual Approach in IgA Nephropathy Management (KI, 2025)

How should practicing physicians adapt their treatment strategies to effectively halt the progressive kidney function loss seen in IgA Nephropathy (IgAN)? The KDIGO 2025 Clinical Practice Guideline provides a critical focused update for managing IgAN and IgA Vasculitis (IgAV), integrating clinical evidence available up to August 2024 to provide robust guidance on diagnosis, prognosis, and treatment12. This updated framework champions a dual therapeutic approach, simultaneously targeting the IgAN-specific pathogenic pathways (IgA-IC formation) and the generic renal responses to nephron loss (hypertension and hyperfiltration)34. The most critical new recommendation is the suggested use of Nefecon, the only treatment to date proven to reduce levels of pathogenic IgA and IgA-containing immune complexes (IgA-ICs), enabling physicians to target the root immunopathology of the disease5.... However, the global applicability of this guideline is challenged by the acknowledged issues surrounding the accessibility and high cost of newly approved treatments like Nefecon and sparsentan in resource-limited settings where IgAN is highly prevalent89. This comprehensive guideline is vital for practitioners as it provides the essential, evidence-based roadmap for implementing optimal combination therapy—including RASi, SGLT2i, and disease-modifying agents—to preserve kidney function for the patient's lifetime1011.

Citation: Kidney Disease: Improving Global Outcomes (KDIGO) IgAN and IgAV Work Group. KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV). Kidney Int. 2025;108(4S):S1–S71. DOI: 10.1016/j.kint.2025.04.004

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