Case Report: Successful Telitacicept Treatment for IgA Nephropathy with Stage 4 Chronic Kidney Disease and Acute Renal Failure

Frontiers in immunology  ·  2026

Fang Zeng; Fei Tan; Dehui Liu; Fang Wang;

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ABSTRACT

Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis and can lead to renal failure requiring renal replacement therapy via dialysis. Current research indicates that telitacicept, an APRIL and BAFF inhibitor, has shown promise as a therapeutic option for IgAN patients with an estimated glomerular filtration rate (eGFR) over 30 mL/min/1.73 m². However, the efficacy of telitacicept in slowing the deterioration of kidney function, especially in individuals with stage 4 chronic kidney disease (CKD) and advancing IgAN, has yet to be documented. We present a 47-year-old male with stage 4 CKD, complicated by acute kidney injury and diagnosed with IgAN via biopsy, who was initially treated with 240 mg of telitacicept for 6 months, then transitioned to a gradual reduction and maintenance therapy for 12 months. After treatment, the proteinuria decreased from 2.82g/day to 0.60g/day. The eGFR gradually increased, improving from 26.95 to 35.69 mL/min/1.73 m² over 18 months. Serum albumin levels increased steadily, while hematuria gradually declined. Immunoglobulins and lymphocytes exhibited a decreasing pattern during treatment, with no notable rise in inflammatory markers. Furthermore, no infections or other adverse events were observed. This case shows the potential for telitacicept to be applied beyond its approved indications. This emphasizes the importance of conducting more research on individuals with advanced chronic kidney disease.

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