Jai Radhakrishnan, MD, is a nephrologist and professor at Columbia University Irving Medical Center.

Jai Radhakrishnan, MD

Navigating Treatment Decisions In IgAN, With Jai Radhakrishnan, MD

Once known as a poorly understood disease with few effective treatment options, IgA nephropathy (IgAN) is now at the center of a rapidly evolving therapeutic landscape. As the treatment armamentarium continues to expand, so too does the complexity of clinical decision-making.

Recent guidelines from Kidney Disease: Improving Global Outcomes (KDIGO) introduced several important clinical changes regarding diagnosis and disease management, including a more liberal kidney biopsy policy and more stringent proteinuria reduction goals.

“The challenge really is to navigate the possibility of how best to treat the patient, given the data that's available,” Jai Radhakrishnan, MD, a nephrologist and professor at Columbia University Irving Medical Center, explained to 

. “Every patient is different, and we have to look at nuances in a given patient to make treatment decisions. That's going to be the biggest challenge in the future.”

He goes on to emphasize urgent unmet needs regarding early diagnosis and referral to nephrology, also noting that managing IgAN effectively extends well beyond the initial presentation. As a lifelong disease, it often requires long-term reassessment and recalibration of treatment plans as patients age and as new therapies emerge. Radhakrishnan says questions remain about how often to adjust therapy or whether repeat biopsies might help guide management decisions over time.

“The other big elephant in the room is the cost of medications,” Radhakrishnan said.

With multiple targeted treatments entering the market and the potential of add on and combination therapy, he cautions that clinicians must carefully weigh the financial impact on both patients and the healthcare system. Radhakrishnan says preventing kidney failure and avoiding dialysis or transplant will offset long-term costs but notes that not all patients will respond equally to these advanced treatments.

“[The guidelines] give you an idea of how best to approach a given patient, but we as practitioners will ultimately need to make the final decision on how best to use these medications,” he concluded.

 reports relevant disclosures with Vertex, Travere, Amgen, Glaxo Smith Kline, Novartis, Vera Therapeutics, Sanofi, and others.

Brooks A. KDIGO Releases Updated IgA Nephropathy, IgA Vasculitis Clinical Practice Guideline. HCPLive. September 18, 2025. Accessed October 10, 2025. 

https://www.hcplive.com/view/kdigo-releases-updated-iga-nephropathy-iga-vasculitis-clinical-practice-guideline

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Radhakrishnan emphasizes the importance of individualized IgAN care and how to best use currently available and emerging treatments.

New Guidelines and Novel Therapies in IgA Nephropathy, With Jai Radhakrishnan, MD

Once known as a poorly understood disease with few effective treatment options, IgA nephropathy (IgAN) is now at the center of a rapidly evolving therapeutic landscape.

Advances in the understanding of its complex pathogenesis and the arrival of targeted therapies are reshaping how clinicians diagnose and manage this rare glomerular disease. However, significant challenges remain, particularly around early detection and timely referral, as many patients continue to present with advanced kidney dysfunction.

“Unfortunately, there's no guideline that mandates yearly checking of the urine for protein or blood in a healthy population,” Jai Radhakrishnan, MD, a nephrologist and professor at Columbia University Irving Medical Center, explained to 

. “As a consequence, patients are missed during the early stages of the disease, where treatment, if available, could have modified the course of the disease.”

Radhakrishnan goes on to describe the growing recognition surrounding the importance of early referral and early diagnosis. After decades of what he describes as a “famine” in IgAN treatments, he says clinicians finally have options to offer their patients.

He says the approach to early diagnosis and treatment was recently “codified” in new guidelines from Kidney Disease: Improving Global Outcomes (KDIGO). In the document, KDIGO encourages a more liberal kidney biopsy policy, suggesting it should be considered in all adults with proteinuria ≥0.5 g/d in whom IgAN is suspected. Regarding treatment, proteinuria reduction goals were reduced to <0.5 g/d while on or off treatment of IgAN, ideally <0.3 g/d (or equivalent), and a stable estimated glomerular filtration rate.

Radhakrishnan also describes the guideline’s focus on treatments that aim to (i) prevent or reduce IgA-containing immune complex (IgA-IC) formation and IgA-IC–mediated glomerular injury and (ii) manage the consequences of existing IgAN-induced nephron loss.

Regarding recent advances in IgAN therapeutics, Radhakrishnan reflects on the availability of treatments that target the known drivers of the disease as well as treatments that control response of proximal pathways of inflammation, including targeted release budesonide, iptacopan, sparsentan, and atrasentan. Looking ahead, he predicts that B cell inhibitors currently in phase 3 clinical trials will eventually enter the therapeutic landscape and provide yet another treatment option, also noting complement inhibitors other than iptacopan currently in the pipeline.

“In a year, 2 years, or 3 years from now, the whole field is going to be radically different in terms of the choices available for treating our patients with IgA nephropathy,” Radhakrishnan said.

Brooks A. KDIGO Releases Updated IgA Nephropathy, IgA Vasculitis Clinical Practice Guideline. HCPLive. September 18, 2025. Accessed October 8, 2025. 

Radhakrishnan breaks down the recent KDIGO IgAN guidelines and describes the evolving therapeutic landscape of IgA nephropathy.

Jai Radhakrishnan, MD

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