Integrating Risk Stratification and Supportive Care in IgA Nephropathy Management

In this episode, Integrating Risk Stratification and Supportive Care in IgA Nephropathy Management, the nephrologists explore the following questions:

How do histologic features (e.g., Oxford MEST-C scores) factor into decision-making? Are they decisive or supportive?

What is the role of supportive therapy now (ACEi, ARB, SGLT2i, endothelin antagonists), and when should providers escalate to disease-specific treatment?

How are you incorporating lifestyle modifications, such as sodium restriction, exercise, and smoking cessation, into routine management of IgAN-related nephron loss, and what challenges do you face in supporting adherence?

Dr. Appel and Dr. Sanchez Russo examined how histologic features, including the Oxford MEST-C scores, play an important but generally supportive role in IgA nephropathy decision-making, helping to contextualize disease activity and chronicity rather than serving as standalone determinants of therapy. Per KDIGO 2025, biopsy findings are best interpreted alongside clinical markers such as proteinuria, eGFR trajectory, and response to initial therapy to refine risk stratification. Supportive therapy remains the foundation of IgAN management, with ACE inhibitors or ARBs used to reduce proteinuria and control blood pressure, and newer agents such as SGLT2 inhibitors and endothelin receptor antagonists further addressing progressive nephron loss. These therapies are typically optimized before escalation to disease-specific treatments, which should be considered in patients with persistent proteinuria or evidence of active disease despite maximal supportive care. Lifestyle modifications, including sodium restrictio

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, Targeted-Release Budesonide in IgA Nephropathy: A Gut–Kidney–Focused Therapeutic Strategy, features the panelists advancing their conversation on IgA nephropathy and focusing on how targeted-release budesonide differs from systemic corticosteroids by selectively modulating gut-associated immune activity to reduce Gd-IgA production while limiting systemic exposure. It also discusses the potential safety advantages of this gut–kidney–axis approach and practical considerations for adding therapy in patients with persistent proteinuria despite optimized supportive care.