News: KDIGO issues new guideline for managing IgAN, IgAV

A new guideline for clinicians managing immunoglobulin A nephropathy (IgAN) and immunoglobulin A vasculitis (IgAV) has been issued by Kidney Disease: Improving Global Outcomes (KDIGO). Published in Kidney International, the guideline makes recommendations based on new clinical finds from randomized controlled trials through August 2024 and reflects the rapid pace at which glomerular disease research is advancing, Medscape Medical News reported.

As the most common primary glomerular disease, IgAN is a leading cause of chronic kidney disease and kidney failure. IgAV similarly carries significant risk for kidney damage, particularly for children. The new guideline is focused on preventing or reducing IgA-containing immune complex (IgA-IC) formation and limiting IgA-IC injury, while also treating complications of IgAN-related damage, like from glomerular hyperfiltration and hypertension. Treatment goals have been revised to a lower proteinuria level of ≤ 500 mg/d and to slow the decline in kidney function to ≤ 1 mL/min/1.73 m2.

“Given the plethora of new therapies approved or in trial for IgAN, the revised guidelines provide a framework for integrating these treatments into daily care,” Brad H. Rovin, MD, professor of medicine and pathology, Lee A. Hebert Professor of Nephrology, director at The Wexner Medical Center for Clinical Research Management in Columbus, Ohio, and co-author of the guideline, told Medscape Medical News. “Some of the newly approved therapies target the presumptive immunopathogenesis of IgAN, while others target the consequences of nephron loss due to IgAN.”

The new recommendations include information on:

• Optimizing the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for all appropriate patients
• Using targeted-release budesonide (nefecon) in those at risk for progressive loss of kidney function
• Employing newer agents, such as sparsentan (a dual endothelin-angiotensin receptor antagonist) and SGLT2 inhibitors, to mitigate IgAN-induced nephron loss
• Handling special situations, including IgAN with nephrotic syndrome, acute kidney injury, or rapidly progressive glomerulonephritis

The update focuses on preserving kidney function by intervening earlier and treating to lower proteinuria thresholds, approaches that should significantly reduce progression to kidney failure and may directly improve kidney survival.

“The guidelines attempt to put the IgAN therapeutic landscape into perspective and provide a rationale of what could be used and where it acts in the IgAN pathway,” Rovin said. “Because trials and new treatments have come so rapidly to the nephrology community, there has been considerable confusion about the new drugs, and when and how to use them.”

Editor’s note: To read Medscape Medical News’ coverage of this story, click here. To access the KDIGO guidance, click here.