Kidney Week

Abstract: TH-PO0525

Combination Therapy in IgAN: A Real-World Case Demonstrating Rapid Reduction in Proteinuria

Session Information

• Glomerular Diseases: IgAN, IgA Vasculitis, and More
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Author

• Reyes Bahamonde, Joselyn, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States

Joselyn Reyes Bahamonde, MD, FASN

Introduction

IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide and is associated with progressive chronic kidney disease (CKD) despite optimized supportive care. Novel disease-specific therapies targeting immune-mediated pathways have recently emerged however, real-world data regarding combination therapy strategies are lacking

Case Description

A 40-year-old obese woman with hypertension, CKD G3aA3, biopsy-proven IgAN, presented with persistent proteinuria despite optimized supportive care with RAS blockade and SGLT2 inhibitors. The patient continued to have significant albuminuria and progression of CKD (Table 1). Sibeprenlimab (anti-APRIL humanized monoclonal antibody) was started in February of 2026, with a near-20% reduction in proteinuria and and improvement of creatinine after one month. Given the patient’s age and risk of progression, Sparsentan, a dual endothelin and angiotensin receptor blockade, was added 4 weeks later as a multitarget therapy approach, with stabilization of kidney function and 89% reduction of proteinuria with good treatment tolerance. (Figure 1,2)

Discussion

Real-world experience with these new agents remains limited. This case highlights the benefit of a combination therapy approach with SGLT2i, endothelin blockade (Sparsentan), and disease-modifying therapy targetin APRIL (Sibeprenlimab) in patients with IgAN and high risk of progression despite optimization of supportive care.

Progression of IgAN

89% reduction of proteinuria in 3 months with combination therapy approach

Stabilization of creatinine with combination therapy approach