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This immunosuppressive treatment regimen is a step-wise therapeutic protocol developed by Yonsei University for the management of IgA nephropathy (IgAN) in patients at high risk of disease progression. The protocol involves an initial phase of corticosteroid therapy (such as methylprednisolone or prednisolone) for patients with persistent proteinuria despite intensive supportive care. For those who do not respond adequately or show rapid kidney function decline after three months, cyclophosphamide is added as an induction agent for a subsequent three-month period, followed by a transition to azathioprine for maintenance therapy. This sequential approach is designed to optimize renal outcomes while monitoring for treatment-related adverse events, addressing the conflicting evidence regarding intensive immunosuppression in IgAN seen in trials like STOP-IgAN and TESTING.
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