IGHA1 and IgA glomerulonephritis: Furthermore, studies indicate that the intestinal microbiome plays a crucial role in the development and progression of IgA nephropathy, potentially through its influence on mucosal immune responses and the production of Gd-IgA1.[19,20] Although we did not conduct a detailed dietary assessment or intestinal microbiome analysis for this patient, the use of delayed-release budesonide is intrinsically linked to this concept, as it targets the intestinal lymphoid tissue where pathogenic IgA originates.