Optimizing Supportive Care for IgAN

In this segment, the panel focuses on what “optimized supportive care” truly means for patients with IgA nephropathy. They emphasize that supportive therapy is not passive; it involves aggressively reducing proteinuria and protecting kidney function. The clinicians outline a structured approach that begins with maximizing RAAS blockade using ACE inhibitors or ARBs at the highest tolerated doses, alongside strict blood pressure control. They discuss incorporating SGLT2 inhibitors as a standard component of supportive care, noting that emerging evidence shows meaningful reductions in proteinuria and slower eGFR decline. Lifestyle modifications—such as dietary sodium restriction, weight management, and smoking cessation—are also highlighted. The group stresses that clinicians must confirm supportive therapy is fully optimized before escalating to immunosuppressive or targeted treatments. Yet, they acknowledge that if proteinuria remains elevated or eGFR continues to fall despite these measures, disease-modifying therapies become necessary. This segment underscores that supportive care is foundational, structured, and closely monitored—not simply a “waiting” phase.