VIDEO: No one-size-fits-all for IgA nephropathy

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KDIGO guidelines provide a great framework for approaching treatment choices. However, as much as we would love to follow a simple algorithm that can help us make a decision, there is unfortunately not one-fit-size-all. When I put together a treatment plan for a patient, I consider patient's biopsy findings, such as the presence and extent of mesangial or endocapillary hypercellularity, crescents, interstitial fibrosis, tubular atrophy, and whether there is TMA present on the biopsy, and so on. The other aspect that guide my decision-making are patient's comorbidities, history of exposure to prior immunosuppressive therapy, or past trial participation, and current interest in trial participation. Lastly, patient preference after an informed discussion can often shape the initial steps of a long-term treatment plan, as can their capability to afford their medication and adhere to a treatment plan.