Do you prefer starting a SGLT2i before steroids in patients with IgA nephropathy and proteinuria > 1.0 gram/day who are unable to tolerate ACEi/ARB due to hypotension?

I do try to start almost all of my IgAN patients on ACE-I/ARB and SGLT2i to help decrease proteinuria. The decision to start steroids or any other immunosuppressive treatment does not always have to wait for 6 months of conservative treatment and if still with residual proteinuria, then consider immunosuppression as the last recommendation in the guidelines for treatment of IgAN. We have more options available for treatment and hopefully the newer guidelines should come out soon guiding the exact question you asked. 

Age of presentation, degree of proteinuria, degree of hematuria, eGFR at presentation, any systemic symptoms to suggest IgA vasculitis, activity on kidney biopsy, and complement deposition on kidney biopsy are some of the factors to consider starting immunosuppression at the same time or soon after ACE-i/ARB and SGLT2i.