Treatment Options for IgA Nephropathy: Understanding Modern Management Strategies

Understanding IgA Nephropathy and Its Global Impact

IgA nephropathy, also known as Berger's disease, is the most common form of primary chronic glomerulonephritis worldwide. It occurs when immunoglobulin A (IgA) deposits build up in the kidneys' filtering units, leading to inflammation and gradual loss of kidney function. If left unmanaged, it can progress to end-stage renal disease. Early diagnosis and a well-structured treatment plan are crucial in slowing disease progression and preserving long-term kidney health.

First-Line Therapy: ACE Inhibitors and ARBs

The Foundation of Kidney Protection

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), commonly known as "prils" and "sartans," are considered the cornerstone of IgA nephropathy treatment. These medications go beyond blood pressure control—they significantly reduce proteinuria (excess protein in the urine), a key marker of kidney damage. By lowering intraglomerular pressure, they help protect the delicate structures within the kidneys from further injury.

Even in patients with normal blood pressure, doctors often prescribe these drugs due to their proven renoprotective effects. Numerous clinical studies support their role in delaying the progression of chronic kidney disease in IgA nephropathy patients. Adherence to this foundational therapy is essential, regardless of whether hypertension is present.

Targeting Active Disease: The Role of Corticosteroids

When Inflammation Requires Stronger Intervention

In cases where IgA nephropathy shows signs of active immune-mediated damage—such as rapidly increasing proteinuria, hematuria, or declining kidney function—corticosteroids may be introduced. These anti-inflammatory agents help suppress the overactive immune response contributing to kidney inflammation.

For patients with high-risk features, a short course of high-dose steroid therapy, sometimes referred to as "pulse therapy," may be recommended. This approach has shown benefit in reducing protein leakage and stabilizing kidney function, particularly when initiated early in the disease course.

Advanced Immunosuppression: When Standard Care Isn't Enough

Managing Chronic or Progressive Cases

In more advanced or slowly progressive forms of IgA nephropathy, especially when there's evidence of chronic scarring on biopsy, additional immunosuppressive therapies may be considered. One such option is tripterygium wilfordii (commonly known as Thunder God Vine or Lei Gong Teng), a plant-derived agent with potent immunomodulatory properties that has been studied for its ability to reduce proteinuria and slow disease progression.

For aggressive or rapidly worsening cases, stronger immunosuppressants like cyclophosphamide may be used in combination with steroids. These regimens are typically reserved for patients at high risk of kidney failure and require close monitoring due to potential side effects, including bone marrow suppression and increased infection risk.

A Personalized Approach to Long-Term Care

Treatment for IgA nephropathy is not one-size-fits-all. It depends on factors such as the level of proteinuria, rate of kidney function decline, histological findings from kidney biopsy, and overall patient health. Emerging therapies, including targeted biologics like budesonide (a gut-targeted steroid), are currently under investigation and may offer new hope for patients in the near future.

Lifestyle modifications—including a low-sodium diet, smoking cessation, regular exercise, and strict blood pressure control—also play a supportive role in managing this condition. Regular follow-ups with a nephrologist ensure timely adjustments to therapy and improve long-term outcomes.