IgAN and Steroids: Key Facts and Considerations

Treatment strategies for immunoglobulin A nephropathy (IgAN) have focused on preventing progression to end-stage kidney disease by slowing the rate of glomerular filtration rate (GFR) loss. Recent evidence indicates that methylprednisolone may reduce the likelihood of reaching primary clinical endpoints, including end-stage kidney disease or a 40% decline in estimated GFR.

IgA nephropathy is one of the most common glomerular diseases globally. The condition carries a significant disease burden, with 30% to 40% of patients eventually developing kidney failure.

Diagnosis and Treatment Goals

According to the KDIGO 2025 Clinical Practice Guideline for the Management of IgAN, the disease cannot be identified through serum or urine biomarkers. The guideline states that IgAN can be diagnosed only with a kidney biopsy, as there are no validated serum or urine biomarkers for the diagnosis of IgAN.

Once diagnosed, the primary therapeutic targets are the reduction of proteinuria and the control of blood pressure. Reducing proteinuria remains the most critical target for clinicians aiming to prevent the progression of the disease.

The Role of Corticosteroids

For several decades, the primary medical options for managing IgAN were limited to corticosteroids or renin-angiotensin-aldosterone system (RAAS) inhibitors. However, the application of steroids has been a subject of ongoing study to determine their efficacy and safety.

Research published in the Journal of Clinical Medicine in February 2024 highlighted the STOP-IgAN and the Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) studies. These trials implemented a run-in period designed to optimize supportive care for patients. Following this period, the studies recruited patients who continued to exhibit significant residual proteinuria.

Data reviewed by the Cleveland Clinic on September 26, 2025, noted that the use of methylprednisolone resulted in a lower likelihood of the primary endpoint, which includes end-stage kidney disease or a 40% decline in estimated GFR.

Clinical Guidelines and Uncertainty

Despite these findings, there has been historical uncertainty regarding the optimal use of steroids. A November 2022 editorial in Kidney Medicine noted that the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Glomerular Diseases Work Group suggested the consideration of steroids given the complexities surrounding the topic.

The evolution of these treatments suggests a shift toward more targeted approaches. While RAAS inhibitors and steroids have been the mainstays of therapy, a deeper understanding of the disease’s pathogenesis is expanding the potential therapeutic options for patients with this glomerular disease.