Evidence-Based Therapies Targeting the Heterogeneity of IgA Nephropathy

The heterogeneous nature of IgA nephropathy (IgAN) necessitates a multifaceted treatment approach. Evidence supports the use of renin–angiotensin–aldosterone system (RAAS) inhibitors and mineralocorticoid receptor antagonists (MRAs) to reduce proteinuria and slow kidney function decline, addressing the hemodynamic and fibrotic components of disease. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated renal-protective benefits across proteinuric kidney diseases, including IgAN, by reducing glomerular hyperfiltration and mitigating disease progression. Glucagon-like peptide-1 (GLP-1) receptor agonists may offer additional kidney and cardiovascular protection, particularly in patients with metabolic comorbidities, complementing traditional therapy. The integration of these agents reflects a personalized approach that targets multiple pathogenic pathways—hemodynamic stress, inflammation, and metabolic dysregulation—allowing clinicians to tailor therapy to individual patient risk profiles and disease characteristics, ultimately aiming to improve long-term renal outcomes in IgAN.