Figure 4. Management of Patients With IgAN Who Remain at High
Risk for Progression After Maximal Supportive Care
Risk/benefit profile of glucocorticoids
should be individually discussed
a
Consider maximal
supportive care
Proteinuria >1 g/d despite at least 3 months of optimized supportive care:
• BP management
• Maximally tolerated dose of ACEi/ARB
• Lifestyle modification
• Address cardiovascular risk
Toxicity risk
stratification:
• Advanced age
• Metabolic syndrome
• Obesity
• Latent infection
(tuberculosis [TB], HIV,
hepatitis B virus [HBV],
hepatitis C virus [HCV])
Specific populations:
• Japanese — consider
tonsillectomy
• Chinese — consider
mycophenolate
mofetil as a
glucocorticoid-
sparing agent
Not applicable to variant forms
of IgA:
• IgA deposition with minimal
change disease
• IgAN with acute kidney injury
• IgAN with a rapidly progressive
glomerulonephritis
Not applicable to:
• IgA vasculitis
• IgA nephropathy secondary to:
» Viral (HIV, hepatitis)
» Inflammatory bowel disease
» Autoimmune disease
» Cirrhosis
• IgA-dominant postinfection GN
Consider enrollment in a clinical trial
eGFR <30 ml/min/1.73 m
2
eGFR ≥30 ml/min/1.73 m
2
a
The TESTING study shows early evidence of efficacy in patients who had
marked proteinuria (2.4 g/d average) at the expense of treatment-associated
morbidity and mortality.
