Chee Kay Cheung MBChB PhD, is a consultant nephrologist and honorary senior lecturer at the University of Leicester.

IgAN Risk, Proteinuria Targets, and KDIGO Updates, With Chee Kay Cheung, MBChB, PhD

The management of IgA nephropathy (IgAN) is undergoing a rapid transformation, driven by a wave of emerging therapies and a deeper understanding of disease progression.

Historically, treatment strategies were constrained by limited options and an imprecise ability to identify which patients were most at risk for kidney decline. The latest update from Kidney Disease: Improving Global Outcomes (KDIGO) reflects a significant shift that moves the field toward more nuanced risk stratification, lower treatment targets, and a growing emphasis on targeted and combination therapies.

 at the World Congress of Nephrology (WCN) Conference in Yokohama, Japan, Chee Kay Cheung, MBChB, PhD, a consultant nephrologist and honorary associate professor at the University of Leicester, noted that one of the most important gaps in prior guidance was the lack of clarity around high-risk patients, with earlier definitions relying heavily on persistent proteinuria despite renin-angiotensin system inhibition.

“Now we have very much an expanding treatment landscape with the development of new targeted therapies for IgA nephropathy… which has meant that the guidelines have had to be revised and continue to be revised to accommodate these exciting developments,” he said.

Risk assessment has also evolved. Cheung points to the IgAN prediction tool as a valuable resource for estimating short- to medium-term risk—up to 7 years—based on large patient cohorts. However, he emphasizes that this falls short of capturing the lifelong trajectory of a disease often diagnosed in patients in their 30s or 40s. As a result, he highlights the need for improved tools that can better predict long-term outcomes and guide therapeutic decision-making.

One of the most notable changes in the updated guidance is a shift in proteinuria targets. Drawing on data from international registries, Cheung notes that even patients with proteinuria between 0.5 and 1 gram per day face a meaningful risk of progression, with approximately 30% advancing to kidney failure within a decade. In response, the guidelines now advocate for reducing proteinuria as much as possible, ideally < 0.3 grams per day.

Cheung also underscores the guideline’s new framework, which categorizes therapies into those targeting upstream immune mechanisms and those addressing downstream consequences of kidney injury. Despite this progress, he stresses that evidence supporting combination approaches remains limited. Determining how best to combine or sequence therapies and ensuring access to these treatments represents a critical unmet need.

Looking ahead, Cheung describes an increasingly complex but promising therapeutic landscape. With additional agents entering clinical use and evolving guidance on their placement, he emphasizes that optimizing treatment strategies will be central to improving long-term outcomes for patients with IgAN.

“I think it's a very exciting time in IgA nephropathy, and there are more treatments coming. These all look very promising in terms of tolerability, in terms of efficacy, and where we place these treatments is going to be a key question in the future as well.”

include Travere Therapeutics, Alexion, Alpine Immune Sciences, Calliditas Therapeutics, CSL Vifor, Novartis, Otsuka Pharmaceutical, Roche, Vera Therapeutics, and others.

Brooks A. KDIGO Releases Updated IgA Nephropathy, IgA Vasculitis Clinical Practice Guideline. HCPLive. September 18, 2025. Accessed March 28, 2026. 

https://www.hcplive.com/view/kdigo-releases-updated-iga-nephropathy-iga-vasculitis-clinical-practice-guideline

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KDIGO updates in IgA nephropathy highlight lower proteinuria targets, improved risk tools, and an expanding landscape of targeted and combination therapies.

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Michelle Bichchau Nguyen, MD, MBA, MPH, is an associate professor of dermatology at Tufts University School of Medicine and the director of Mohs Micrographic Surgery.


What Are the Biggest Drivers of Dissatisfaction in Dermatology? With Michelle Nguyen, MD, MBA, MPH

In a second interview segment recorded at the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 in Denver, Michelle Bichchau Nguyen, MD, MBA, MPH, associate professor of dermatology at Tufts University School of Medicine and director of Mohs Micrographic Surgery, spoke with 

 about her practical guidance on the most common drivers of patient dissatisfaction in dermatology.

Specifically, Nguyen went into what early-career clinicians can do in order to build more meaningful, lasting connections with their patients. When asked to identify the single biggest driver of dissatisfaction in dermatology practices, Nguyen pointed directly to the challenge of high patient volume and the toll it can take on the quality of each of these encounters.

“[Just] the fact that you're sitting down and having a conversation instantly make patients feel like…it's worth it to wait three months to see you and paying the co-pays and all of that,” Nguyen expressed.

In a specialty where clinicians are routinely required to interact with large numbers of patients in relatively short windows of time, Nguyen pointed out, it becomes can be all the more critical to be intentional about making each these individuals feel heard and valued. Nguyen also described the physical act of sitting during a patient conversation, rather than standing at the door or typing at a workstation, as immediately making the clinician appear present and engaged.

Additionally, Nguyen reframed the time investment in rapport-building as a long-term strategic asset, as opposed to only a courtesy. Concerns left unaddressed in a single visit, she explained, tend to compound over time. This can make future encounters more difficult and the therapeutic relationship more fragile. Dermatology clinicians who invest upfront in building trust, she expressed, ultimately benefit from greater patient loyalty.

Turning to advice for early-career dermatologists specifically, Nguyen further highlighted an important dimension to her earlier guidance on listening: do not take negative feedback personally. Nguyen noted critical patient reviews can sting for clinicians, especially those who are newer. Rather than internalizing those situations as reflections of their worth as clinicians, Nguyen encouraged residents and junior physicians to mine each piece of criticism for a kernel of actionable truth.

Nguyen had no relevant financial disclosures of note.

Nguyen M. Ways to Improve Patient Experience with Surgery in Dermatology, With Michelle Nguyen, MD, MBA, MPH. HCPLive. March 27, 2026. 

https://www.hcplive.com/view/ways-improve-patient-experience-surgery-dermatology-michelle-nguyen-md-mba-mph

Gahona M, Prada SA, Chaparro D. Patient satisfaction as a quality indicator in dermatological care: cross-sectional study in two tertiary institutions with residency programs. An Bras Dermatol. 2025 Nov-Dec;100(6):501228. 

. Epub 2025 Nov 3. PMID: 41187473; PMCID: PMC12634491.

This interview at AAD 2026 highlights Nguyen's views on the biggest drivers of patient dissatisfaction in dermatology practice settings.

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Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

New 52-week data from a phase 3b trial of tildrakizumab (Sun Pharma, ILUMYA) in moderate-to-severe nail psoriasis, presented at the 

 held in Denver, Colorado, from March 27-31, show continued improvement in nail clearance and sustained response among early responders — extending results first reported at last year’s meeting.¹

The study (NCT03897075) is the first dedicated phase 3b trial of an IL-23 inhibitor in nail psoriasis, a manifestation affecting roughly 40–50% of patients with plaque psoriasis that remains among the most difficult-to-treat domains of the disease due to the slow growth rate of the nail plate and limited long-term clinical trial data.²

The multicenter, randomized, double-blind, placebo-controlled study enrolled 99 adults with moderate-to-severe plaque psoriasis and concurrent nail involvement, defined by a modified Nail Psoriasis Severity Index (mNAPSI) score of ≥20 and a ViSENPsO score of ≥3. Patients received tildrakizumab 100 mg or placebo; those originally randomized to placebo crossed over to tildrakizumab at week 28.¹

The primary endpoint of mNAPSI 75 response at week 28  was met, with 25.5% of tildrakizumab-treated patients achieving ≥75% improvement from baseline versus 4.5% in the placebo arm (

 = .003). Additionally, 29.4% of tildrakizumab-treated patients achieved a ViSENPsO score of 0 (normal) or 1 (minimal) with a ≥2-point decrease from baseline, compared to 4.2% with placebo (

Among 72 patients who completed the study through week 52, of which 40 were originally randomized to tildrakizumab and 32 originally to placebo, response rates in the continuous tildrakizumab arm continued to increase beyond week 28. The mNAPSI 75 response rate rose from 25.5% at week 28 to 41.2% at week 52, and 76.9% of week-28 mNAPSI 75 responders maintained that response at week 52.¹

A similar trajectory was observed for the ViSENPsO endpoint. The proportion achieving normal or near-normal nails increased from 29.4% at week 28 to 43.1% at week 52, with 60.0% of week-28 ViSENPsO responders sustaining that response at week 52.¹

The continued gains between weeks 28 and 52 are consistent with the biology of nail psoriasis treatment: fingernails take approximately 6 months to fully regenerate, meaning the full benefit of anti-inflammatory therapy on nail architecture emerges gradually and is often not captured at earlier timepoints.²

Investigator Paul Yamauchi, MD, PhD, President and Director of Dermatology, Dermatology Institute and Skin Care Center, and colleagues saw that safety through week 52 was consistent with tildrakizumab's established profile. Serious adverse events (AEs) occurred in 3 patients (5.9%) originally randomized to tildrakizumab. AEs of special interest were reported in 2 patients (3.9%) — 1 injection-related reaction and one case of pruritus. Missing data were imputed as nonresponse throughout.¹

Tildrakizumab selectively binds the p19 subunit of IL-23, suppressing downstream signaling through the Th17 axis that drives both cutaneous and nail manifestations of psoriasis. The drug is approved in the United States, Australia, Japan, and Europe (as ILUMETRI, marketed by Almirall) for moderate-to-severe plaque psoriasis. Sun Pharma also recently received Food and Drug Administration (FDA) acceptance of an sBLA for tildrakizumab in active PsA, with a PDUFA date of October 29, 2026, based on positive topline results from the INSPIRE-1 and INSPIRE-2 phase 3 trials.

Data from the AAD 2026 presentation represent the complete 52-week dataset for this nail psoriasis study. Full publication in a peer-reviewed journal is anticipated.

Yamauchi P, et al. Efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis affecting the nails: a multicenter, randomized, double-blind, placebo-controlled phase 3b trial. Presented at: 2026 AAD Annual Meeting; March 27–31, 2026; Denver, CO. Poster #72762

Renert-Yuval Y, Guttman-Yassky E, et al. Nail psoriasis: an updated review of currently available systemic treatments. 

Articles

Tildrakizumab is US FDA-approved for treating adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

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The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Tildrakizumab Sustains Nail Psoriasis Efficacy Through 52 Weeks in Phase 3b Extension Data

Ways to Improve Patient Experience with Surgery in Dermatology, With Michelle Nguyen, MD, MBA, MPH

Patient experiences with dermatology practices and, especially, with surgery often require clear communication as well as gentle guidance by clinicians seeking to improve patient satisfaction.

Michelle Bichchau Nguyen, MD, MBA, MPH, associate professor of dermatology at Tufts University School of Medicine and director of Mohs Micrographic Surgery, addressed this topic in her session presented at the 

 to speak on some of her tips for patient satisfaction improvements.

“[What] patient care even more than that is how they are treated before, during and after the visit,” Nguyen explained.

Nguyen's core message suggested surgical outcomes, while essential, are not necessarily what patients will remember the most. What matters more to them, she pointed out, is how they are treated at every stage of the encounter, suggesting the need for clear, step-by-step explanations of what a procedure involves.

Throughout her interview, Nguyen also made a strong case for the underappreciated role of staff in shaping the surgical experience. She noted the considerably increased time staff spend with patients compared to the time patients spend with physicians. She described empowering them to educate, comfort, and answer questions independently as a direct investment in the satisfaction of patients.

Nguyen was asked for a single distilled pearl from her talk for newer clinicians and she pointed to one piece of advice: ask and listen. Rather than leading with only information, Nguyen encouraged dermatology clinicians to first figure out what a patient is actually concerned about, then address those specific concerns rather than defaulting to a standard script.

For any additional information on these tips, view the full interview segment posted above. To learn more about sessions and new data presented at AAD, view the 

Queen D, Trager MH, Samie FH, et al. Patient Satisfaction of General Dermatology Providers: A Quantitative and Qualitative Analysis of 38,008 Online Reviews. JID Innov. 2021 Aug 19;1(4):100049. 

This interview at AAD 2026 highlights tips for clinicians in dermatology practices who want to improve patient communication and satisfaction.

Abdallah Geara, MD, is an Associate Professor of Clinical Medicine at the University of Pennsylvania.

Corey Cavanaugh, DO, is an academic nephrologist at the Cleveland Clinic. 

2 IgA Nephropathy Experts Explain Clues For Early Intervention and Diagnosis

Two experts in nephrology are emphasizing the importance of identifying early clinical signs of IgA nephropathy (IgAN), often described as a silent disease.

“Clinicians should pay close attention to hypertension—especially in younger patients—and microscopic hematuria, again particularly in younger individuals,” said Corey Cavanaugh, DO, an academic nephrologist at the Cleveland Clinic, in an interview with HCPLive. “This is largely a young person’s disease, and it can be easy to explain these findings away or attribute them to something other than IgA nephropathy, since they’re relatively nonspecific. That’s why it requires a high index of suspicion and an astute clinician, particularly among non-nephrologists. It can be very subtle.”

Since these early findings are often attributed to benign or transient causes, diagnosis can often wind up delayed. By the time a majority of patients are diagnosed with IgAN, 50% to 75% have already progressed to chronic kidney disease (CKD) stage 3. At this point, eGFR falls below 60 mL/min/1.73 m² and structural kidney damage becomes irreversible, underscoring a need for earlier intervention. 

IgAN’s symptoms can be clinically silent before they progress to worsened stages, including non-visible hematuria, proteinuria, impaired kidney function, or hypertension. In one recent analysis, approximately 60% of IgAN cases were detected incidentally through hematuria or proteinuria identified on routine urinalysis. As a result, clinicians must rely heavily on measurable markers to assess disease activity and progression risk, with proteinuria remaining one of the most important indicators of long-term outcomes.

“When it comes to prognostication, we have to integrate clinical markers—serum creatinine, proteinuria, and hypertension—with demographic factors, including age and ethnicity, as well as histologic markers,” said Abdallah Geara, MD, Associate Professor of Clinical Medicine at the University of Pennsylvania, in an interview with HCPLive. “Bringing these together allows us to create a risk assessment for each patient, which then guides the next step in treatment. As therapies continue to evolve, the treatment algorithm has changed quite a bit over the last few years and will likely keep evolving.”

As the IgAN treatment landscape is experiencing a therapeutic revolution, this approach to risk stratification is becoming increasingly important. With 5 recently approved agents across distinct mechanistic pathways, therapeutic options are no longer the primary limitation. Instead, the focus is shifting toward earlier identification and precise risk assessment to ensure these therapies are deployed at a stage when they can have the greatest impact.

Editor’s Note: Abdallah reports relevant disclosures with Amgen, GlaxoSmithKline, Novartis, and others. Cavanaugh reports relevant disclosures with Otsuka Pharmaceutical Co, Novartis Pharmaceutical Corporation, Travere Therapeutics, and Vera Therapeutics.

Stoneman S, Teh JW, O’Shaughnessy MM. IgA nephropathy in adults. 

. Published online January 26, 2026. doi:10.1001/jama.2025.25020

Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. 

. 2021;100(4S):S1-S276. doi:10.1016/j.kint.2021.05.021

Corey Cavanaugh, DO, and Abdallah Geara, MD, separately share their perspectives on the clinical clues for IgAN diagnosis, including hypertension and microscopic hematuria.

Strategic Alliance Partnership

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

These new data on spesolimab (Spevigo) in adults with generalized pustular psoriasis highlight long-term findings with the treatment.

EFFISAYIL ON: New Long-Term Data Released on Spesolimab Injection for GPP

Monica Kraft, MD, is Murray M. Rosenberg Professor of Medicine and System Chair for the Department of Medicine at Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai.

Deep learning applied to routine ECGs identified COPD up to 15 months earlier, supporting earlier intervention and risk stratification strategies.


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Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

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Latest News

IgAN Risk, Proteinuria Targets, and KDIGO Updates, With Chee Kay Cheung, MBChB, PhD

What Are the Biggest Drivers of Dissatisfaction in Dermatology? With Michelle Nguyen, MD, MBA, MPH

Tildrakizumab Sustains Nail Psoriasis Efficacy Through 52 Weeks in Phase 3b Extension Data

Ways to Improve Patient Experience with Surgery in Dermatology, With Michelle Nguyen, MD, MBA, MPH

2 IgA Nephropathy Experts Explain Clues For Early Intervention and Diagnosis