The topline. San Juan, October 23, 2026. IgA nephropathy often starts in young adults and follows them for decades toward kidney failure, and for most of its history the treatment options were thin. This week at ASN Kidney Week 2026, three Phase 3 programs reported two-year kidney protection, and the FDA granted a fourth therapy accelerated approval. Four advances in one week is not how this disease usually moves.

Key facts

The strongest result belongs to sibeprenlimab. In the Phase 3 VISIONARY trial, the APRIL inhibitor reduced the risk of serious kidney function loss or kidney failure in adults with IgA nephropathy by 97 percent compared with placebo, with kidney function remaining stable over two years. APRIL is one of the immune drivers of the disease, and the trial targeted it selectively.

Two other programs attack the same biology through dual inhibition of BAFF and APRIL. In the ORIGIN 3 trial, atacicept achieved a statistically significant reduction in protein-to-creatinine ratio at week 36, and its two-year analysis showed eGFR stabilization and a marked reduction in kidney disease progression risk, with safety comparable to placebo and no increased infection signal. The drug already carries accelerated approval after FDA review and is delivered through a self-administered autoinjector. In TELIGAN, the dual inhibitor telitacicept slowed kidney function loss and substantially reduced kidney failure risk in high-risk patients over two years, with a favorable safety profile.

Separately, the FDA granted Ultomiris (ravulizumab) accelerated approval for reducing proteinuria in adults with primary IgA nephropathy at risk of progression. It is the first C5 complement inhibitor approved for the indication, based on a 43.4 percent placebo-adjusted proteinuria reduction at 34 weeks in the I CAN study. Confirmation of eGFR benefit at week 106 is still pending.

Clinical relevance

IgA nephropathy is a lifetime-risk disease in often young patients, so two-year durability data matters more than biomarker snapshots. The honest caveat: VISIONARY and TELIGAN are conference presentations, not yet peer reviewed, and accelerated approvals rest on proteinuria as a surrogate, with full benefit still to be proven. But the direction is unmistakable: the field has moved from managing decline to targeting the immune drivers, with multiple mechanisms, multiple delivery routes, and real long-term numbers. For the nephrologist in the room, the question is shifting from whether anything works to which pathway fits which patient.

97%

That is the risk reduction sibeprenlimab reported for serious kidney function loss or kidney failure against placebo, with function stable at two years. Numbers that large in a chronic kidney disease trial invite skepticism until the full paper lands, and that is the right instinct. But even halved, it would be the strongest disease-modifying result IgA nephropathy has ever seen. A week with four answers is rare in nephrology. The papers will tell us which ones hold.

What we’re reading

  • American Society of Nephrology: the Kidney Week 2026 program and presented abstracts.
  • Medical Xpress: the October 22 summary of the three trials.
  • U.S. Food and Drug Administration: approval actions and labeling for new kidney indications.