[Brussels, Belgium] — Kidney Disease: Improving Global Outcomes (KDIGO) is pleased to announce the publication of The 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV) in Kidney International.

Co-chaired by Jürgen Floege, MD (Germany) and Brad Rovin, MD (United States), the guideline provides comprehensive, evidence-based recommendations for clinicians managing these common and complex kidney diseases, reflecting an unprecedented pace of scientific advancement in glomerular disease research.

IgAN is the most common primary glomerular disease and a leading cause of chronic kidney disease and kidney failure. IgAV, historically known as Henoch–Schönlein purpura, also carries significant risks for kidney damage, particularly in children. The new guideline integrates evidence from randomized controlled trials through August 2024 to provide clinicians with the most up-to-date recommendations for diagnosis, prognosis, and treatment.

A significant advance is the focus of management to simultaneously prevent or reduce IgA-containing immune complex (IgA-IC) formation and IgA-IC injury while treating the complications of IgAN-related kidney damage, including glomerular hyperfiltration and systemic hypertension.

Key recommendations include optimized use of ACEi or ARB for all patients, targeted-release budesonide (Nefecon) for those at risk of progressive loss of kidney function, and newer agents such as sparsentan (a dual endothelin angiotensin receptor antagonist) and sodium-glucose cotransporter-2 (SGLT2) inhibitors to manage responses to IgAN-induced nephron loss. The guideline also provides guidance for special situations such as IgAN with nephrotic syndrome, acute kidney injury, or rapidly progressive glomerulonephritis. Additional guidance for pregnancy planning and managing IgAN in children is also provided.

The guideline also highlights global challenges. Many regions with the highest prevalence of IgAN, such as Asia, remain underrepresented in clinical trials and face barriers to accessing newly approved therapies. KDIGO emphasizes the need for equity so that advances benefit all patients, not only those in resource-rich settings.

Recognizing the rapid pace of new discoveries, KDIGO is committed to updating this guideline on an ongoing basis. Work is already underway to review emerging data and integrate newly approved therapies as they become available, ensuring healthcare providers and patients have access to the most current guidance.

"This guideline represents a fundamental shift in how we approach IgA nephropathy," said Dr. Floege. "For the first time, we can simultaneously target the immune mechanisms that drive IgA-containing immune complex injury and the maladaptive responses of the kidney to nephron loss. This dual strategy provides clinicians with a scientifically grounded roadmap to slow disease progression and extend kidney survival in ways that were not possible just a few years ago."

"The science is moving faster than ever, and the treatment landscape for kidney diseases driven by IgA has changed dramatically," said Dr. Rovin. "We now have multiple approved therapies such as targeted-release budesonide, sparsentan, and SGLT2 inhibitors that allow us to intervene earlier and tailor care to each patient's needs. What makes this guideline so important is that it shows clinicians how to integrate the latest evidence with practical strategies to preserve kidney function and improve lives. With this update, we are entering a new era where these conditions are no longer managed with a single approach but with a toolkit of therapies that can truly change outcomes for people with these complex diseases around the world."

The KDIGO 2025 IgAN/IgAV Guideline is available on the Kidney International and KDIGO websites and will be published in the October print issue of Kidney International.