Figure 6. Risk Stratification and Treatment Strategy in IgA Nephropathy.

Created by the authors with BioRender.com.

A tiered management strategy for IgA nephropathy integrating clinical risk features with targeted therapies. High-risk patients are identified by persistent proteinuria, histologic activity (e.g., MEST-C scores), and declining GFR. Goals of therapy include remission of proteinuria and hematuria, stabilization of eGFR, and prevention of ESRD. Strategy includes RAAS blockers, SGLT2 inhibitors, and newer agents such as sparsentan and targeted-release budesonide (nefecon), tailored based on patient profile and response.

eGFR = Estimated glomerular filtration rate, MEST-C = Mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis, and crescents, RAAS = Renin-angiotensin-aldosterone system, SGLT2 = Sodium-glucose cotransporter 2 (SGLT2) inhibitors, APRIL = A proliferation-inducing ligand, BAFF = B-cell activating factor, MMF = Mycophenolate mofetil