Efficacy of SGLT2 inhibitors in preventing end-stage kidney disease in patients with IgA nephropathy: a scoping review

ObjectivesTo conduct a scoping review mapping the extent, nature, and consistency of available evidence regarding the effects of sodium–glucose cotransporter-2 (SGLT2) inhibitors on kidney function, proteinuria, kidney outcomes, and mortality in patients with IgA nephropathy (IgAN).MethodsThis scoping review was conducted in accordance with the PRISMA-ScR guidance. Randomized controlled trials (RCTs) including patients with IgAN were identified to characterize high-level efficacy signals. Observational studies, real-world cohorts, and mechanistic investigations were additionally included to contextualize and extend the randomized evidence. Findings were mapped across five predefined outcome domains: acute eGFR dip, chronic eGFR slope, proteinuria reduction, kidney outcomes, and mortality.ResultsTwo large randomized controlled trials, DAPA-CKD and EMPA-KIDNEY, provided randomized evidence supporting kidney-protective effects of SGLT2 inhibitors in IgAN subgroups. Complementary observational and real-world studies consistently demonstrated clinically meaningful reductions in proteinuria, stabilization of kidney function trajectories, and mechanistic patterns linking early hemodynamic responses with longer-term renal benefit. Mortality data specific to IgAN remain limited; however, indirect evidence from broader CKD populations suggests biological plausibility for cardiovascular and survival benefits.ConclusionThe available evidence supporting SGLT2 inhibitors in IgA nephropathy is broad, convergent across study designs, and mechanistically coherent. Although disease-specific randomized trials remain limited, consistent signals from randomized, observational, and mechanistic evidence support the role of SGLT2 inhibitors as kidney-protective therapy in IgAN and highlight priorities for future IgAN-focused research.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=630522, identifier (CRD42025630522).