Historical and Evolving Approaches to IgA Nephropathy: From Supportive Care to Updated Guidelines

EP: 1.Exploring the Complex Nature of IgA Nephropathy

EP: 2.The Impact of Underdiagnosis and a Pivotal Moment in Care

EP: 3.Evolving Management and Pathogenesis of IgA Nephropathy

EP: 4.Diagnosis and Risk Stratification in IgA Nephropathy: Biopsy and Biomarkers

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EP: 5.Historical and Evolving Approaches to IgA Nephropathy: From Supportive Care to Updated Guidelines

EP: 6.Evidence-Based Therapies Targeting the Heterogeneity of IgA Nephropathy

Historically, IgA nephropathy (IgAN) management focused on supportive measures, including blood pressure control, renin–angiotensin system blockade, and general kidney-protective strategies. While these approaches help slow disease progression, they do not directly target the underlying immune-mediated pathogenesis, leaving many patients at risk for continued kidney injury and eventual end-stage renal disease. Recent updates in KDIGO 2025 reflect a more nuanced understanding of IgAN and aim to improve early detection and risk stratification. Notable changes include a more liberal approach to kidney biopsy, enabling earlier histologic diagnosis, and a lower proteinuria threshold for initiating therapy, which may allow timely intervention in higher-risk patients. These updates, combined with emerging targeted therapies, underscore a shift toward individualized, mechanism-based management strategies designed to optimize long-term outcomes in IgAN.