The three figures from the recent KI GN update 2021 summarizes IgA nephropathy.
Basically, At this point, given negative studies for steroids, only thing we have that has strong evidence is conservative management. Interestingly, SGLT2i did not make it to the guidelines. ACEI/ARB+ SGLT2i might be the best treatment options we have for IgA Nephropathy.
The one place where immunosuppressive meds will help is Crescentic IgA nephropathy and IgA with MCD.
Here is the final table on all meds and their data from KDIGO
Does immunosuppressive meds help IgA nephropathy? Do we await the budesonide directed therapy approval, do we await more supportive agents such as ET1 antagonists or Aldo antagonists? Time will tell. Till then, IgA nephropathy is still the hardest GN to treat as we don't have clear options for treating the pathophysiology of the disease.