Immunoglobulin A nephropathy is a common primary glomerular disease, and its targeted therapy focuses on key links such as upstream regulation of galactose-deficient immunoglobulin A1 production, blocking immune complex deposition, inhibiting complement activation, and downstream inflammatory responses. This article systematically reviews the latest research progress of targeted therapeutic drugs based on the pathogenesis of immunoglobulin A nephropathy, summarizes their mechanisms of action and clinical research evidence, and explores the current challenges and future development directions, in order to provide references for clinical practice and research.