Complement inhibitors and B cell–modifying agents for IgA nephropathy—a Kidney Disease: Improving Global Outcomes (KDIGO) commentary

Kidney International, vol. 110, pp. 502–507

Abstract

Kidney Disease: Improving Global Outcomes (KDIGO) updated its clinical practice guideline for the management of glomerular diseases in 2021, more than a decade after the first glomerular diseases guideline was published, reflecting slow progress in drug development. But since then, novel therapies for several glomerular diseases have been successfully tested and approved by regulatory agencies, none more so than IgA nephropathy (IgAN). To keep pace with new therapies, the IgAN guideline was updated again in 2025. After this revision came to press, 3 additional IgAN treatments received accelerated approval by the US Food and Drug Administration. Because the presumptive mechanisms of action of 2 of these new therapies are mechanistically different from those of previously approved drugs, the KDIGO IgAN Work Group felt that a brief commentary outlining where the new therapies may fit into the overall IgAN treatment strategy was warranted in lieu of a full guideline update, pending additional evidence for these and other therapies.

Authors 9

1. Brad H. Rovin corresponding

   The Ohio State University Wexner Medical Center · The Ohio State University

   Affiliation as printed

   Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA. Electronic address: Brad.Rovin@osumc.edu

2. Jonathan Barratt

   University of Leicester

   Affiliation as printed

   Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

3. H. Terence Cook

   Imperial College London

   Affiliation as printed

   Department of Immunology and Inflammation, Imperial College London, London, UK

4. Irene L. Noronha

   Universidade de São Paulo

   Affiliation as printed

   Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil

5. Heather N. Reich

   University of Toronto

   Affiliation as printed

   Divsion of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

6. Yusuke Suzuki

   Juntendo University

   Affiliation as printed

   Department of Nephrology, Juntendo University, Tokyo, Japan

7. Sydney C.W. Tang

   University of Hong Kong

   Affiliation as printed

   Division of Nephrology, Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China

8. H. Trimarchi

   Hospital Británico de Buenos Aires

   Affiliation as printed

   Division of Nephrology and Renal Transplantation, Hospital Británico de Buenos Aires, Buenos Aires, Argentina

9. Jürgen Floege corresponding Aachen Division of Nephrology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Division of Nephrology, University Hospital, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany. Electronic address: jfloege@ukaachen.de