New Horizons in IgA Nephropathy: Approach to Current and Emerging Therapies.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis globally, exhibiting marked diversity in clinical presentation, risk of progression, and response to therapy. Despite advances in understanding its pathophysiology, including the pivotal role of galactose-deficient IgA1 (Gd-IgA1), anti-Gd-IgA1 autoantibodies, and dysregulated mucosal and systemic immune responses, therapeutic options remain limited. This review provides a comprehensive overview of the current therapeutic landscape in IgAN, which is stratified into conservative care with renin-angiotensin-aldosterone system (RAAS) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and corticosteroids, and newer advances like the endothelin receptor antagonists, immunosuppressive agents, and targeted therapeutics. Through synthesizing evidence from recent clinical trials and ongoing studies, we aim to provide clinicians and researchers with a current and forward-looking perspective on therapeutic strategies in IgAN, emphasizing the shift from conservative therapy to targeted, individualized interventions.