IgA Nephropathy Clinical Trials and Treatments

IgA nephropathy (IgAN, Berger disease) is a chronic kidney disease caused by deposition of galactose-deficient IgA1 (Gd-IgA1) antibodies in the glomerular mesangium. The disease involves a multi-hit pathogenesis: elevated levels of abnormally glycosylated IgA1, formation of autoantibodies against Gd-IgA1, immune complex formation, and mesangial deposition triggering inflammation and glomerular injury. The clinical course is highly variable.

The most common symptoms of IgA Nephropathy include Blood in the urine (hematuria), often visible during or after upper respiratory infections, Protein in the urine (proteinuria) detected on lab tests, Flank or abdominal pain during episodes of visible hematuria, High blood pressure (hypertension), Swelling in hands and feet (edema) in advanced disease, among others. About 2 new cases per 100,000 people each year in the U.S., and an estimated 199,000 to 208,000 Americans were living with IgA nephropathy in 2021 (Otsuka-funded study, Clinical Nephrology, 2025). About 1 in 10 kidney biopsies in the U.S. show IgA nephropathy (NIDDK). Significantly more common in East Asian and Pacific Islander populations, with reported incidence up to 4 times higher. Symptoms can range from mild to severe and may vary between individuals.

Trial Friend lists all active clinical trials for IgA Nephropathy from ClinicalTrials.gov, with eligibility criteria translated into plain English. Patients can filter by trial phase and recruitment status, search by location, and use the Match Me tool to score trials against their profile. IgA nephropathy treatment has transformed dramatically, with 7 disease-specific FDA-approved therapies now available: targeted-release budesonide (Tarpeyo), the endothelin blockers Filspari (sparsentan, which also blocks angiotensin) and Vanrafia (atrasentan), the complement inhibitors Fabhalta (iptacopan) and Ultomiris (ravulizumab), the APRIL inhibitor Voyxact (sibeprenlimab), and Trutakna (atacicept), approved in July 2026 as the first FDA-approved dual BAFF/APRIL inhibitor. Ultomiris is the newest, with accelerated approval announced by AstraZeneca on October 21, 2026.

Yes. Seven medicines are FDA approved specifically for IgA nephropathy: Tarpeyo (budesonide delayed-release) in December 2021, Filspari (sparsentan) in February 2023, Fabhalta (iptacopan) in August 2024, Vanrafia (atrasentan) in April 2025, Voyxact (sibeprenlimab) in November 2025, Trutakna (atacicept) in July 2026, and Ultomiris (ravulizumab) on October 21, 2026. Tarpeyo, Filspari and Fabhalta hold full approval to slow the loss of kidney function. The other 4 are approved to lower protein in the urine, and it is not yet established whether they slow kidney decline. The Treatments section of this page lists each one. The FDA is due to decide on Povetacicept by November 30, 2026; the FDA calendar page carries the outcome the day it lands.

IgA nephropathy follows a multi-hit pathogenesis. First, the immune system produces abnormally glycosylated IgA1 (Gd-IgA1) lacking galactose residues. Second, autoantibodies recognize and bind to Gd-IgA1, forming immune complexes. Third, these complexes deposit in the kidney's mesangium, triggering complement activation, inflammation, and progressive glomerular injury. Genetic variants in complement factor H, APRIL/BAFF signaling, and HLA genes increase susceptibility. The Oxford MEST-C biopsy classification (mesangial hypercellularity, endocapillary proliferation, segmental sclerosis, tubular atrophy, crescents) predicts progression risk and guides treatment decisions.

IgA nephropathy is not a single-gene disease but involves multiple genetic risk factors identified through genome-wide association studies, including variants in CFHR1, CFHR3, CFH (complement pathway), TNFSF13 (APRIL), and HLA region genes. Diagnosis requires a kidney biopsy showing IgA deposits in the kidney's filters. Genetic counseling can help assess familial risk.

Eligibility for IgA Nephropathy clinical trials depends on factors like age, diagnosis, treatment history, and overall health. Each trial sets its own inclusion and exclusion criteria. Trial Friend translates these requirements from medical language into plain English so patients can review them more easily. The Match Me tool can score your profile against active trials to help identify studies that may be a fit.

Participating in a IgA Nephropathy clinical trial typically involves scheduled visits, medical tests, and close monitoring by a research team. Depending on the study phase, you may receive an investigational treatment, a placebo, or the current standard of care. Trials may last from a few weeks to several years. Study participation is voluntary, and you can withdraw at any time.

IgA nephropathy clinical trials frequently exclude competing targeted therapies including complement inhibitors, APRIL/BAFF pathway blockers, and endothelin receptor antagonists, often with specific washout periods. However, an ACE inhibitor or ARB at the highest dose you tolerate is typically required for enrollment, not excluded, and most recent trials allow a stable SGLT2 inhibitor without requiring one. Trial Friend's medication conflict checker scans each trial's exclusion criteria against common IgAN medications including sparsentan (Filspari), iptacopan (Fabhalta), sibeprenlimab (Voyxact), TARPEYO, immunosuppressants like mycophenolate and rituximab, and standard nephrology medications. The checker flags the specific drug, exclusion language, and a confidence level so you can discuss timing with your nephrologist.

Key questions to ask your nephrologist about IgAN clinical trials include: Is my proteinuria still above 1g/day despite maximum RAAS blockade and SGLT2 inhibition, making me a candidate for newer targeted trials? What washout period would I need from my current immunosuppressant? Am I eligible for APRIL/BAFF pathway trials based on my Gd-IgA1 levels? At what eGFR decline rate should we prioritize trial enrollment before I fall below eligibility cutoffs? If I start sparsentan, does it replace my ARB or add to it? What are the risks of stopping current treatment during a washout period?