摘要IgA肾病是全球范围内最常见的原发性肾小球疾病，亚洲地区发病率最高，其进展至终末期肾病的风险高，即便是尿蛋白较低的患者。目前IgA肾病的治疗理念发生了重要变化，治疗中应减少致病性IgA和IgA免疫复合物的形成，包括肠道黏膜B细胞免疫调节剂如布地奈德肠溶胶囊、靶向增殖诱导配体（a proliferation inducing ligand，APRIL）和肿瘤坏死因子家族B细胞活化因子（B cell activating factor of the tumor necrosis factor family，BAFF）制剂及B细胞消耗剂；也应管理肾小球炎症，包括糖皮质激素、霉酚酸酯、羟氯喹、补体靶向治疗；并同时管理肾单位丢失引起的一般反应，包括生活方式干预、肾素-血管紧张素系统抑制剂、钠-葡萄糖共转运蛋白-2抑制剂、内皮素受体拮抗剂。本文对IgA肾病的治疗理念及药物进展进行了全面梳理，旨在为IgA肾病患者提供更合理的治疗方案，从而改善患者预后。

abstractsIgA nephropathy is the most common primary glomerular disease globally, with the highest incidence in the Asian region, and has a high risk of progressing to end-stage renal disease even in patients with low proteinuria. The treatment paradigm for IgA nephropathy has undergone significant changes. Treatment should aim to reduce pathogenic IgA and IgA immune complex formation, including intestinal mucosal B cell immune modulators such as budesonide enteric-coated capsules, targeted APRIL and BAFF agents, and B cell depletors; it should also manage glomerular inflammation, including corticosteroids, mycophenolate mofetil, hydroxychloroquine, and targeting complement therapy; and it should manage general responses to nephron loss, including lifestyle interventions, renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and endothelin receptor antagonists. This article provides a comprehensive overview of the treatment paradigm and drug advancements for IgA nephropathy, aiming to provide more rational treatment options for IgA nephropathy patients and improve their outcomes.