Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV)
Abstract
The Immunoglobulin A nephropathy (IgAN) and Immunoglobulin A vasculitis (IgAV) management guideline was last updated and published as part of the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Based on new developments in IgAN assessment and therapy, a major update of the guideline was necessary in 2024. Compared with the last version, the KDIGO 2025 IgAN guideline now encourages a more liberal kidney biopsy policy and suggests aiming for stricter proteinuria control, with a goal of <0.5 g/d, ideally <0.3 g/d, and a stable estimated glomerular filtration rate. A major new concept in the 2025 guideline is to initiate treatment with (i) therapies that prevent or reduce pathogenic IgA production and IgA/IgA and IgA/IgG immune complex formation along with (ii) therapies to manage the consequences of existing IgAN-induced nephron loss. Approaches to achieve the first aim are currently limited to targeted-release budesonide (Nefecon) or reduced-dose systemic corticosteroid therapy and, in Chinese patients, mycophenolate mofetil. Approaches to the more generic second aim include healthy lifestyle education, renin-angiotensin system blockers, sodium-glucose cotransporter-2 inhibitors, and/or dual endothelin angiotensin receptor blockers. Little has changed for special situations of IgA-dominant immune complex glomerular diseases such as nephrotic syndrome, acute kidney injury, rapidly progressive…
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