As the most common primary glomerular disease worldwide, IgA nephropathy (IgAN, also known as Berger’s disease) has become a major public health issue in the field of chronic kidney disease in China. It is also a common and frequently encountered disease in the nephrology departments of primary and all levels of medical institutions.
Clinical data show that approximately 54.3% of renal biopsy cases in China are IgA nephropathy, with a total patient population exceeding 5 million and more than 120,000 new cases annually. The disease predominantly affects young adults aged 20–30 years. If progressive, it can lead to end-stage renal disease (ESRD), which not only imposes a heavy burden on patients and their families but also raises higher requirements for the guarantee of clinical medication.
Against the huge patient base, continuously growing clinical demand for IgA nephropathy, and the core orientation of “improving quality, controlling costs, and ensuring supply” in China’s pharmaceutical procurement sector, DengYue Medicine, as a professional pharmaceutical wholesale and supply integration platform, systematically analyzes the market structure and procurement adaptability of commonly used drugs and innovative targeted drugs for IgA nephropathy based on the 2025 KDIGO Guidelines and Chinese clinical diagnosis and treatment norms.
This paper proposes procurement strategies for IgA nephropathy-related drugs from three dimensions: changes in clinical demand, product structure upgrading, and supply chain stability, helping medical institutions and partners achieve optimized product portfolio and risk-controllable growth.
I. Core Background of Clinical Diagnosis and Treatment of IgA Nephropathy
The core pathogenesis of IgA nephropathy is the abnormal production of galactose-deficient IgA1 (gd-IgA1), formation of immune complexes via autoantibody binding, and deposition in the glomerular mesangium, triggering inflammation and renal injury (the four-hit hypothesis). Clinical manifestations mainly include episodic gross hematuria, asymptomatic microscopic hematuria with proteinuria. Some patients may progress to hypertension and renal failure. Major complications include acute renal failure and chronic renal failure, which seriously impair patients’ quality of life.
At present, the treatment of IgA nephropathy focuses on delaying renal function deterioration, controlling proteinuria, and stabilizing blood pressure, adopting a stratified treatment model: basic supportive therapy + immunosuppressive therapy + novel targeted therapy. Medication needs vary significantly among patients at different disease stages and pathological classifications (Oxford Classification).
In line with 2026 pharmaceutical procurement policy trends (implementation of dual medical insurance and commercial insurance catalogs, optimized centralized procurement rules, unified procurement of county-level medical consortia), pharmaceutical procurement must balance four core elements: clinical necessity, policy adaptability, cost-effectiveness, and supply stability, so as to achieve a win-win situation of “guaranteed clinical support, effective procurement benefits, and reliable supply support”.
II. Classification of Commonly Used Clinical Drugs for IgA Nephropathy and Procurement Recommendations
Based on clinical usage frequency, guideline-recommended levels, and procurement adaptability, IgA nephropathy-related drugs are divided into three categories: basic essential drugs, immunosuppressive drugs, and novel targeted drugs. The procurement value, applicable scenarios and core advantages of each category are clarified to support wholesalers in precise product layout.
Basic Essential Drugs
These drugs serve as fundamental treatment for all IgA nephropathy patients, with stable clinical demand, large consumption, and strong policy adaptability. They are core essential categories for pharmaceutical wholesalers, suitable for all levels of medical institutions (tertiary hospitals, community health service centers, county-level hospitals), especially matching the needs of primary chronic disease management. With stable repurchase cycles and protection from centralized procurement and medical insurance policies, they are the core foundation for securing the basic procurement market.
1. RAS Inhibitors (ACEI/ARB)
Core representative drugs: Valsartan, Losartan, Irbesartan, Benazepril, Enalapril, etc.
Clinical value: The first-line basic drugs recommended by guidelines, which can lower blood pressure, reduce proteinuria, protect the glomerular filtration barrier, and delay renal function decline. They are suitable for all IgA nephropathy patients with hypertension and proteinuria. The target blood pressure is controlled at <120/70 mmHg, and proteinuria at <0.5 g/d (ideally <0.3 g/d). As the “cornerstone” of IgA nephropathy treatment, the incidence of hypertension in adult IgA nephropathy patients reaches 20% and increases with disease progression, further expanding clinical demand.
Procurement recommendations:
① Prioritize generic drugs that have passed consistency evaluation, which are cost-effective, clinically recognized, and in line with centralized procurement trends. Most such drugs have been included in national centralized procurement with controllable prices and a payment cycle shortened to within 30 days, effectively easing capital pressure.
② Cover different dosage forms (tablets, capsules) to meet convenient administration needs for primary patients.
③ Select manufacturers with stable supply and sufficient production capacity to ensure regular supply for medical institutions at all levels, especially county-level medical consortia, supporting the implementation of primary chronic disease management policies.
2. Diuretics (adjunctive antihypertensive / anti-edema drugs)
Core representative drugs: Spironolactone, Furosemide, Torasemide, etc.
Clinical value: Adjunctive drugs for IgA nephropathy patients with edema or poorly controlled hypertension. They can rapidly relieve edema and synergistically lower blood pressure, especially for patients with acute nephritic syndrome or massive proteinuria with edema. They are clinically necessary adjuvant drugs with stable and scattered demand, suitable for various terminal scenarios.
Procurement recommendations:
① Focus on clinically common specifications to avoid redundancy, and prioritize small-dose, easy-to-take dosage forms.
② These low-cost and abundantly supplied drugs allow bulk procurement to reduce costs. As basic adjuvant drugs, sufficient inventory must be maintained to avoid shortages.
③ For primary medical institutions, focus on cost-effective conventional varieties in line with the “high quality and reasonable price” procurement orientation.
Immunosuppressive Drugs
These drugs are suitable for medium- to high-risk IgA nephropathy patients with proteinuria >1 g/d, impaired renal function, or severe mesangial proliferation with crescent formation. Clinical demand is concentrated in tertiary hospitals and specialized nephrology departments, belonging to “precise necessity” categories. With moderate profit margins and partial inclusion in medical insurance, they have good policy adaptability. They are an important supplement for wholesalers to enhance category competitiveness, especially supporting the construction of hospital specialty departments.
1. Glucocorticoids (core traditional immunosuppressive drugs)
Core representative drugs: Prednisone, Methylprednisolone, etc.
Clinical value: Classic immunosuppressive drugs that potently inhibit glomerular inflammation, reduce proteinuria, and delay renal function progression. Used for medium- to high-risk IgA nephropathy patients with a treatment course of 6–8 months. They can serve as alternatives when targeted budesonide is unavailable, with wide clinical application and high recognition as foundational immunosuppressants.
Procurement recommendations:
① Prioritize clinically common specifications (tablets, injections). Injections are mainly for inpatients, and tablets for long-term outpatient use, covering diverse terminal needs.
② Select manufacturers with stable quality and good reputation, as quality differences directly affect clinical efficacy despite being conventional drugs.
③ Control inventory scale to avoid overstock, while ensuring timely supply to meet the staged treatment needs of medium- to high-risk patients, and reasonably stock up according to the procurement cycles of tertiary hospitals.
2. Other Immunosuppressive Drugs
Core representative drugs: Mycophenolate mofetil (MMF), Cyclophosphamide, Tacrolimus, etc.
Clinical value: Used for refractory IgA nephropathy patients with severe pathological changes (such as crescentic nephritis), poor response or intolerance to glucocorticoids. They can synergistically suppress immune responses and reduce proteinuria. Mycophenolate mofetil is indicated for Chinese adult IgA nephropathy patients as a supplementary clinical drug. Demand is concentrated but dosage is relatively controllable, providing an important treatment option for refractory cases and filling unmet clinical needs.
Procurement recommendations:
① As specialized drugs, prioritize cooperation with tertiary hospitals and nephrology specialized hospitals to precisely match demand and avoid blind stocking.
② Pay attention to medical insurance policy adaptability. Some varieties have been included in medical insurance; prioritize catalog-listed drugs to improve terminal procurement willingness.
③ Choose manufacturers with stable supply and academic support to facilitate clinical promotion with terminals, in line with the academic promotion trend of innovative and specialized drugs, and enhance category competitiveness.
Novel Targeted Drugs
These drugs represent a major breakthrough in IgA nephropathy treatment in recent years. They target the core pathogenesis and belong to “etiological treatment”, with clear efficacy and mild side effects, and are strongly recommended by the 2025 KDIGO Guidelines. Although relatively expensive at present, market demand will grow rapidly with medical insurance access and increased clinical penetration. They are core categories for pharmaceutical wholesalers to layout the future and seize high-growth tracks, in line with the procurement trend of innovative drugs, and can serve as the core engine for profit improvement, especially suitable for the differentiated needs of tertiary hospitals and specialty clinics.
1. Targeted Budesonide (Nefecon)
Core positioning: The first approved targeted intestinal mucosal immune drug for IgA nephropathy, recommended as one of the first-line immunosuppressive treatments in the 2025 KDIGO Guidelines. It is the current global standard first-line new drug and the core targeted therapy option for Chinese IgA nephropathy patients, with a 9-month treatment course, suitable for patients still at risk of progression after supportive therapy. As the only etiological treatment drug, clinical demand is growing rapidly. The Chinese IgA nephropathy therapeutic drug market is expected to reach USD 507 million by 2030, and such targeted drugs will become the core growth driver.
Clinical value: Ileal-targeted release, acting only at the terminal ileum, inhibiting abnormal IgA1 production at the source, significantly reducing proteinuria and delaying renal function decline. Systemic side effects are much lower than traditional oral steroids. Suitable for medium- to high-risk patients with persistent proteinuria after RAS inhibitor therapy, especially those intolerant to traditional steroid side effects. It can effectively improve long-term prognosis, reduce the risk of progression to end-stage renal disease, and alleviate the social medical burden.
Procurement recommendations:
● Focus on medical insurance access progress. Such drugs have been gradually included in medical insurance; prioritize catalog-listed specifications to enhance terminal procurement competitiveness, in line with the policy orientation of dual medical insurance and commercial insurance coordination.
● Select original or regularly authorized generic manufacturers to ensure drug quality and efficacy. As new targeted drugs, quality directly affects clinical trust.
● Precisely connect with tertiary hospitals and nephrology specialized hospitals for early layout to seize high-growth markets, and provide supporting manufacturer academic training to meet terminal clinical upgrading needs.
● Control initial inventory, gradually adjust stocking volume combined with clinical penetration, balance profitability and inventory risk, in line with the “precise layout, gradual volume expansion” procurement logic for innovative drugs.
2. Atrasentan
Core positioning: An endothelin receptor antagonist specifically for proteinuric IgA nephropathy, a promising novel targeted drug in nephrology, which can fill the treatment gap for refractory patients, in line with the procurement trend of innovative drugs in high-growth tracks. It is an important variety for wholesalers’ differentiated layout, especially suitable for patients with poor response to RAS inhibitors, with scarce and targeted clinical demand.
Clinical value: By blocking endothelin A receptors, it reduces intraglomerular hypertension, inflammation and fibrosis, potently lowers proteinuria and protects podocytes. It can be combined with RAS inhibitors to further reduce proteinuria and delay eGFR decline. Suitable for IgA nephropathy patients with refractory proteinuria, especially those with hypertension and mild renal impairment. Clinical application scenarios are clear, demand is concentrated and growth potential is large, which can effectively improve the diagnosis and treatment level of terminal medical institutions and meet the needs of specialty department construction.
Summary
IgA nephropathy has a huge patient population in China and presents a clear trend of stratified diagnosis and treatment, standardized therapy, and targeted upgrading. Under the policy background of “improving quality, controlling costs, and ensuring supply”, pharmaceutical procurement should adopt a structured strategy: stabilize the basic drug market, precisely allocate immunosuppressive drugs, and strategically layout targeted drugs.
Basic drugs represented by RAS inhibitors and diuretics are the cornerstone to stabilize market volume and ensure stable supply. Immunosuppressive drugs such as glucocorticoids and mycophenolate mofetil are key to improving professional competitiveness and meeting the medication needs of medium- to high-risk patients. Novel targeted drugs including budesonide and atrasentan represent the future direction of clinical treatment and are the core engine for seizing high-growth markets and enhancing profitability.
Relying on its professional supply chain integration capability and in-depth insight into clinical and policy trends, Dengyue Medicine will continue to provide safe, stable, cost-effective and policy-adapted drug solutions for medical institutions and partners. Through precise category layout and efficient supply chain empowerment, we will jointly promote the standardized diagnosis and treatment and sustainable development of IgA nephropathy, and create greater value for clinical practice, patients and the entire industrial chain.
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