Abstract: SA-PO0653
Practice Variability and Individualized Treatment Selection in IgAN in the Era of Emerging Therapies
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - Other
October 24, 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
Authors
- Reyes Bahamonde, Joselyn, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
- Trivedi, Hina, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
- Sureja, Dhaval, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
- Bal, Swomya, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
Background
The treatment of IgA Nephropathy (IgAN), has rapidly evolved with novel therapies SGLT2 inhibitors (SGLT2i), endothelin receptor antagonists, Budesonide, complement, and APRIL pathway inhibitors. However, limited data exist for an optimal treatment strategy. As a result, nephrologists rely on personal clinical judgment. The goal of this study is to evaluate the variability in treatment strategy among nephrologists treating IgAN in the era of emerging targeted therapies
Methods
We reviewed the management of IgAN among nephrologists from a single center using individualized treatment strategies based on proteinuria, eGFR, comorbidities, biopsy findings, and risk of progression. In parallel, nephrologists completed a survey evaluating factors influencing treatment selection and triggers for escalation therapy.
Results
A review of five patients with biopsy-proven IgAN demonstrated significant variability in treatment approach utilizing SGLT2i, Sparsentan, and Sibeprenllimab (Figure 1a).
Survey responses showed substantial variability in therapy decision-making (Figure 1b). Risk factors like persistent proteinuria, eGFR decline, and Oxford MEST score were among the most important. These findings suggest that nephrologists prioritize both clinical and histologic factors of progression when choosing a treatment strategy. Regarding the preferred escalation therapy: 42.9% of participants selected combination therapy, 42.9% SGLT2i, and 14.3% Tarpeyo. These findings reflect interest in a multi-target approach, but it also highlights the absence of standardized treatment guidelines. Regarding an important trigger for therapy intensification. 50% considered persistent proteinuria, 33.3% prioritized rapid disease progression, and 16.7% high risk biopsy findings
Conclusion
Real-world management of IgAN shows substantial variability in treatment selection and escalation strategies among nephrologists. Development of standardized risk stratification models integrating clinical and histological factors is needed to guide combination therapy strategy and individualized treatment in IgAN
Acknowledgment
Nephrology Department, St Luke's University Health Network