Guideline Recommendations for Sibeprenlimab in IgA Nephropathy

Supportive Care Optimization

The KDIGO guideline advises that patients with IgA nephropathy should receive a maximally tolerated dose of an ACE inhibitor or ARB as part of standard care. 1
KDIGO recommends targeting a clinic blood pressure of < 120/70 mm Hg, measured using standardized office techniques. 1
Sodium intake should be limited to < 2.0 g per day to aid blood‑pressure control and reduce proteinuria. 5

Serum creatinine and estimated glomerular filtration rate (eGFR) should be checked regularly while on sibeprenlimab, in line with KDIGO monitoring recommendations. 3
Continuation of ACE inhibitor/ARB therapy is advised unless there is a > 30 % rise in serum creatinine or refractory hyper‑kalemia develops, per KDIGO guidance. 4
Electrolyte panels, especially serum potassium, must be monitored in patients receiving RAS blockade to detect and manage abnormalities promptly. 5
Metabolic acidosis should be treated when serum bicarbonate falls below 22 mmol/L, as recommended by KDIGO. 5
Patients should be instructed to temporarily hold ACE inhibitor/ARB therapy during periods of volume depletion or acute illness (“sick days”). 7
If potassium levels become elevated, potassium‑wasting diuretics or potassium‑binding agents may be employed to maintain normokalemia and allow ongoing RAS inhibition. 5

Lifestyle counseling—including sodium restriction, weight management, smoking cessation, and regular physical activity—is recommended alongside pharmacologic therapy for IgA nephropathy. 5

Sibeprenlimab is intended as an add‑on disease‑modifying therapy and should be used in addition to, not as a replacement for, optimized supportive care that includes RAS inhibition and strict blood‑pressure control. 1