Patient handout

IgA Nephropathy

PRODUCTION

1. Your condition

This handout is for iga nephropathy. Your care team identified this based on: gross hematuria 1-3 days after uri (synpharyngitic — pathognomonic) (kdigo 2021 gn).

Other reasons your team may use this plan: persistent microscopic hematuria + proteinuria (kdigo 2021 gn); egfr decline >50% over days-weeks (crescentic iga → route renal.rpgn.core.v1) (kdigo 2021 gn); renal biopsy with dominant iga deposition on if (kdigo 2021 gn).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
lisinopril	10 mg PO daily, titrate to max tolerated (typically 40 mg)	PO	daily	KDIGO 2021 GN — max-dose ACEi/ARB is foundation; titrate to BP <120/70 + minimize proteinuria
losartan	50-100 mg PO daily, titrate to max tolerated	PO	daily	KDIGO 2021 GN — ARB equivalent first-line if ACEi cough/angioedema
empagliflozin	10 mg PO daily	PO	daily	EMPA-KIDNEY + DAPA-CKD — SGLT2i slows progression of proteinuric CKD including IgAN subgroup; KDIGO 2024 CKD
dapagliflozin	10 mg PO daily	PO	daily	DAPA-CKD Heerspink NEJM 2020 — alternative SGLT2i; KDIGO 2024 CKD

Plan: IgA nephropathy stepwise therapy — optimized supportive → budesonide → sparsentan/refractory (KDIGO 2021 GN; NefIgArd Lancet 2023; PROTECT Lancet 2023)

3. When to call your provider

Contact your care team if any of the following happen:

Rapidly rising UPCR + falling eGFR despite ladder → re-biopsy + specialty referral (KDIGO 2021 GN)
New gross hematuria + falling eGFR → consider crescentic-IgA → route renal.rpgn.core.v1 (KDIGO 2021 GN)
CKD progression toward ESRD → transplant evaluation → route neph.ckd.core.v1 (KDIGO 2024 CKD)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

RPGN-IgA crescentic — rapid eGFR decline + RBC casts + crescents on biopsy → route renal.rpgn.core.v1 (KDIGO 2021 GN)(life-threatening)
Nephrotic-range proteinuria >3.5 g/d in IgAN — guarded prognosis (KDIGO 2021 GN)
CKD progression to ESRD — ~25-30% of IgAN at 20 years; transplant evaluation (KDIGO 2024 CKD)
High Oxford MEST-C activity on biopsy — M1/E1/S1/T1/T2/C1/C2 (Mesangial / Endocapillary / Segmental sclerosis / Tubular atrophy / Crescents) (Coppo Kidney Int 2014; KDIGO 2021 GN)
High risk per International IgA Nephropathy Risk Prediction Tool (Barbour Kidney Int 2018) — eGFR + UPCR + BP + MEST-C + race → 5-yr 50% eGFR decline/ESRD risk (Barbour 2018 PMID 30980653)
IgA Vasculitis (Henoch-Schönlein purpura) — palpable purpura + arthralgia + GI involvement + IgA nephritis (KDIGO 2021 GN)
Continued progression on budesonide — sparsentan or refractory regimens (PROTECT Lancet 2023)
Pregnancy intent or pregnancy on sparsentan — teratogen; REMS contraception mandatory (PROTECT Lancet 2023; FDA REMS)

5. Follow-up

q3-6 month nephrology visits; CV-risk modification (statin per ACC/AHA Lipid 2026); transplant evaluation if approaching ESRD; vaccination + lifestyle (KDIGO 2021 GN; KDIGO 2024 CKD)

6. Sources

Guideline: KDIGO 2021 Glomerular Diseases (Kidney Int Oct 2021) + NefIgArd Lafayette Lancet 2023 (budesonide Tarpeyo FDA 2023) + PROTECT Heerspink Lancet 2023 (sparsentan Filspari FDA 2023) + STOP-IgAN Rauen NEJM 2015 (negative for immunosuppression vs supportive) + TESTING Lv JAMA 2017 (corticosteroids — infection signal) + Oxford MEST-C update Trimarchi Kidney Int 2017 + International IgA Nephropathy Risk Prediction Tool (Barbour JAMA Intern Med 2019) + KDIGO 2024 CKD + EMPA-KIDNEY/DAPA-CKD SGLT2i