We are entering a golden age for treatment of IgA nephropathy, with a large array of novel therapies likely to enter clinical practice over the next 5 years. This will allow us for the first time to simultaneously target a number of different pathogenic pathways in IgA nephropathy with the aspiration to prevent kidney failure in the lifetime of our patients. In this talk I will discuss the current umet need in IgA nephropathy and the scale of the challenge we face if we are to prevent kidney failure in the life time of our patients. I will describe our current understanding of the pathogenesis of IgA nephropathy and how these new therapies target specific aspects of the pathogenic cascade. I will review the available phase 2 and 3 clinical trial data and finish with a discussion on how we might combine these new therapies in the future and which combinations are likely to be safe, tolerable and effective, and ideally how we get the "right" drug(s) to the "right" patient at the "right" time. To do this we will need companion biomarkers to help guide clinical decision making and I will discuss the progress we are making in this regard, although we have a long way to go at the present time.