<p>As seen at <strong>Kidney Week 2025</strong>, recent advances are enabling clinicians to set a higher bar for outcomes for their patients with IgA nephropathy (IgAN). Guidelines emphasize the goal of preserving nephrons and avoiding progression to kidney failure within the patient’s lifetime.</p> <p><br></p> <p><em>Following these presentations, featured expert Myda Khalid, MD, was interviewed by </em>Conference Reporter<em> Editor-in-Chief Tom Iarocci, MD. Clinical perspectives from Dr Khalid on these findings are presented here.</em></p>

These are exciting times in IgAN, and it is important to review how we arrived at this point. The 2025 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines are informed by numerous past studies, including work by Aliza M. Thompson, MD, MS, and colleagues showing that proteinuria can be used as a surrogate end point. This was truly game changing because it shortened the timeline for conducting clinical trials and accelerated the reporting of primary end point results.

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The NefIgArd trial, for example, enrolled patients with IgAN who had proteinuria despite optimized RAS blockade. Patients were randomized to receive 9 months of targeted-release budesonide or placebo and then were observed for 3 months. At the 9- and 12-month time points, patients in the budesonide group had improvements in their 24-hour urine protein to creatinine ratio and estimated glomerular filtration rate.

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This was a major advancement, and it led to an explosion of clinical trials of new agents for IgAN, including sparsentan, complement inhibitors, and BAFF and APRIL inhibitors. In fact, at Kidney Week 2025, we saw positive phase 3 data for the dual BAFF and APRIL inhibitor atacicept from Richard A. Lafayette, MD, during the opening plenary session and for the APRIL inhibitor sibeprenlimab from Vlado Perkovic, MBBS, PhD, FASN, in abstract SA-OR086. All of this was initially spurred on by the medical community coming together to do right by our patients, to address the need for more practical clinical trial end points.

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At the same time, we also began seeing data suggesting that IgAN is not as benign as we once thought, as discussed during our session at Kidney Week 2025. In this regard, the UK National Registry of Rare Kidney Diseases (RaDaR) is one of the most widely recognized registries. In its IgAN cohort, high rates of kidney failure within 10 years of diagnosis were associated with lower levels of proteinuria (ie, levels that were traditionally regarded as being low risk). We have come to understand that IgAN needs to be treated more aggressively given that the majority of patients have a risk of developing kidney failure in their lifetime. We now have these medications that can actually change the trajectory of this disease, which is absolutely fantastic, and the new KDIGO guidelines came in this context.

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There are a couple of points in the KDIGO guidelines that stand out to me. One is that patients with IgAN ideally should be a part of a registry, which is very helpful because this allows us to better define the natural history using real-world data. And then, of course, the proteinuria reduction targets are very important: ideally, urine protein to creatinine ratio should be less than 0.5. If we can prevent people from reaching end-stage kidney failure with the tools we currently have, we need to do it.

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One of the major points of discussion in multistakeholder groups such as the IgAN Alliance is the need to identify patients affected by IgAN earlier in its course. This is where registries such as the Cure Glomerulonephropathy (CureGN) consortium are so important. We are planning research to tease out the natural history of IgAN in children, including in those with IgA vasculitis, because we need additional data on outcomes in children and young adults to better understand the spectrum of disease.

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And it is also our responsibility in the kidney community to get the word out that things have changed. There are now new treatments, and it is likely that more are on the way. In fact, new drug trials are coming out at such a rapid pace that it can be hard to keep up. Along those lines, more frequent updates from KDIGO are anticipated. It will be very interesting to watch for an ability to update these guidelines in real time as the clinical trial results become mature.