Immune-mediated renal injury and cardiometabolic risk in IgA nephropathy: clinical evidence on telitacicept from a scoping review.

Background: Immunoglobulin A nephropathy (IgAN) is not only the most common primary glomerular disease but also a chronic inflammatory condition associated with increased cardiometabolic risk through the cardiorenal axis. Persistent proteinuria and progressive renal dysfunction are linked to adverse cardiovascular and metabolic outcomes and may complicate the delivery of long-term lifestyle and nutritional risk-modifying strategies. Telitacicept, a dual BAFF/APRIL inhibitor, has emerged as a targeted immunomodulatory therapy for IgAN, yet the clinical evidence remains heterogeneous. Methods: We conducted a scoping review of clinical studies evaluating telitacicept in biopsy-confirmed IgAN. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to 2 January 2026. Randomized and observational studies reporting renal outcomes were included. When available, cardiometabolic- and nutrition-related variables (e.g., blood pressure, lipid profile, uric acid, body weight/BMI, inflammatory markers, and lifestyle/nutritional counseling) were also captured. Results: Twenty-four studies were identified, including one randomized controlled trial, 16 observational studies, and seven case reports/series. Across studies, telitacicept consistently reduced proteinuria (approximately 49-87%) while maintaining stable estimated glomerular filtration rate. Additional reported benefits included improvements in serum albumin-likely reflecting reduced urinary protein loss-and glucocorticoid-sparing effects. The therapy was generally well tolerated, with predominantly mild adverse events. Notably, cardiometabolic and nutritional endpoints were inconsistently reported across the current literature, limiting definitive conclusions regarding these outcomes. Conclusion: Current evidence suggests that telitacicept may offer a promising targeted therapeutic option for IgAN by achieving sustained proteinuria reduction and renal function stabilization. From a clinical practice perspective, improved renal and inflammatory control may facilitate the implementation of long-term nutritional and metabolic risk-modifying strategies in high-risk IgAN populations; however, direct evidence linking telitacicept to cardiometabolic or nutritional endpoints remains scarce. Larger, long-term randomized studies incorporating prespecified cardiometabolic and nutritional outcomes are warranted.