Summary: Treatment options for IgA nephropathy (IgAN) must take into consideration the pathophysiology, namely the role of eicosanoids, angiotensin II and monocyte-macrophages releasing reactive oxygen species (ROS). Angiotensin converting enzyme inhibitors and early corticosteroid usage are prime therapies. Tonsillectomy should be considered. Other components of a therapeutic cocktail could be; (a) thromboxane antogonist, (b) leukotriene antagonist, (c) platelet activating factor antagonist, (d) an anti-oxidant and (e) an anti-fibrotic agent like pentoxyfylline. In the new millenium, there will be focus on anti-proliferative measures like platelets dependent growth factor aptamers. For unusual cases with rapid progression, the use of FK-506 or mycophenolate mofetil can be considered.