What Is the First-Line Treatment for IgA Nephropathy?
IgA nephropathy (IgAN) carries a risk of progressive, potentially irreversible kidney function loss in a substantial proportion of patients. First-line management is structured around slowing that progression through renin-angiotensin system inhibition, adjunctive pharmacological options, lifestyle modification, and strict blood pressure control — guided by validated quantitative targets.
Treatment approach
Treatment targets
- Urine protein excretion < 0.5 g/d (ideally < 0.3 g/d)
- Rate of kidney function loss < 1 ml/min/yr
- Blood pressure ≤ 120/70 mm Hg
References
- We recommend that all patients with IgAN be treated with an optimized maximally tolerated dose of either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) (1B).
- Control of blood pressure with a target of ≤120/70 mm Hg.
- The treatment goal in patients with IgAN at risk of progressive loss of kidney function is to reduce the rate of loss of kidney function to the physiological state (i.e., <1 ml/min/yr for most adults) for the rest of the patient's life.
- The only validated early biomarker to help guide clinical decision-making is urine protein excretion, which should be maintained at a minimum of <0.5 g/d (or equivalent), and ideally at <0.3 g/d (or equivalent), accepting that in some patients with extensive kidney scarring, this may not be possible and that multiple treatment strategies, including nonpharmacologic interventions, may be needed to achieve this.