Sayna Norouzi, MD, is an assistant professor of medicine and clinical nephrologist at Loma Linda University Medical Center

Sayna Norouzi, MD

 are diagnosed later than men and are less likely to begin dialysis or receive a kidney transplant, according to a new American Heart Association (AHA) scientific statement published in 

.¹ For women diagnosed young with a rare or autoimmune kidney disease, one of the statement’s co-authors says the burden of CKD begins long before those endpoints.

“This is a topic that is really close to my heart because it’s focused on women’s kidney health. So the fact that we are paying more attention to women’s kidney health and it’s coming from AHA, it’s huge,” Sayna Norouzi, MD, assistant professor of medicine and clinical nephrologist at Loma Linda University Medical Center and director of its Glomerular and Polycystic Kidney Diseases Clinics, said in an interview with 

Family Planning and CKD in Young Women, With Sayna Norouzi, MD

Why CKD Is Diagnosed Later and Treated Less Often in Women

CKD affects about 1 in 10 women worldwide, but the condition may go unrecognized longer in women than in men.¹˒² Kidney function is typically estimated using creatinine, and because women tend to have less muscle mass and produce less creatinine, those estimates may not accurately reflect their kidney function. As a result, some cases are misclassified or caught later.²

That delay carries through to treatment. Women tend to begin dialysis at a lower level of kidney function than men, and globally, men receive kidney transplants about 30% more often than women. In some low and middle income countries, the gap exceeds 10 to 1.² The authors cite caregiving responsibilities, cultural expectations, limited health literacy, and treatment costs as barriers that may keep women from reaching specialist care.²

Female-Specific Risk Factors for CKD Across the Lifespan

The statement frames kidney health as closely tied to reproductive health at every life stage. Preeclampsia and other pregnancy complications may signal greater future risk of kidney disease, heart disease, and stroke, while natural menopause before age 45 and surgical removal of the ovaries before age 50 are each linked with a greater risk of CKD.²

Polycystic ovary syndrome and lupus, which is more common in women than men, are also associated with greater CKD risk. Among people with diabetes, the leading cause of CKD worldwide, some evidence suggests women may progress to kidney failure at higher rates than men.²

Family Planning After an IgA Nephropathy or Lupus Nephritis Diagnosis

For Norouzi, the women most affected by these gaps are often those with glomerular and autoimmune kidney diseases. Patients with IgA nephropathy or lupus nephritis are frequently diagnosed young, she said, which means the effects of CKD extend well beyond eventual dialysis or transplant and shape how they navigate life from the point of diagnosis.

In her clinic, which includes patients with lupus nephritis, IgA nephropathy, and C3 glomerulopathy, those concerns surface almost immediately. “The moment we talk about chronic kidney disease, they’re going to ask questions about how they’re going to have a family, if they can get pregnant, if they can have kids,” she said. Patients also ask whether they should get married and whether to tell a partner about their diagnosis, Norouzi added, questions that lead her to wonder whether clinicians are paying enough attention to the burden of CKD in women.

The statement supports bringing those conversations into routine care. Pregnancy in women with CKD may increase the risk of disease progression and pregnancy complications, and managing blood pressure, blood sugar, and body weight is suggested for women with CKD planning a pregnancy. The authors recommend embedding reproductive health assessment into CKD care as a step toward more precise kidney medicine.²

Closing the Evidence Gap for Women With CKD

Women remain underrepresented in CKD trials, and few studies report results by sex, which limits how well the evidence applies to women.³ Women may also respond differently to kidney therapies because of differences in how drugs are absorbed, distributed, metabolized, and cleared.² The statement calls for enrolling enough women in trials to detect differences in treatment effects, reporting results by sex and reproductive health factors, and studying sex-specific pharmacokinetics and pharmacodynamics to guide dosing and drug selection.²˒³

For Norouzi, better evidence needs to translate into better support for patients over the long term.

“Yes, there are endpoints of ending up on dialysis and transplant, but how getting diagnosed with CKD is going to affect their life choices, and how they’re going to navigate life after being diagnosed with rare disease and CKD at such a young age, that’s something that we should pay more attention to and come up with better solutions for our patients on how to navigate CKD and complications throughout life,” she said.

Editors’ note: Norouzi reports relevant disclosures with Calliditas, Travere, Apellis and others.

Gohar EY, Shah S, Oh ES, et al. Women’s kidney health in focus: a scientific statement from the American Heart Association. 

. Published online September 17, 2026. doi:10.1161/CIR.0000000000001471

American Heart Association. Women’s kidney health may be overlooked, delaying critical prevention and treatment opportunities. News release. September 17, 2026. Accessed October 8, 2026. 

https://newsroom.heart.org/news/womens-kidney-health-may-be-overlooked-delaying-critical-prevention-and-treatment-opportunities

American Heart Association. Women’s kidney health in focus. Science News. September 17, 2026. Accessed October 8, 2026. 

https://professional.heart.org/en/science-news/womens-kidney-health-in-focus

Videos

An AHA statement co-author says reproductive and family planning concerns belong in kidney care for women with glomerular disease.

How Glomerular Disease Shapes Young Women's Life Choices, With Sayna Norouzi, MD

Two years of data from the phase 3 ORIGIN 3 trial show atacicept (Trutakna) stabilized kidney function and lowered the risk of kidney disease progression compared with placebo in adults with primary 

.¹ The final efficacy analysis adds long-term kidney outcome data for a therapy currently approved only on the basis of proteinuria reduction.¹

Final analysis of the phase 3 ORIGIN 3 trial showed atacicept (Trutakna) stabilized kidney function in adults with primary IgA nephropathy (IgAN). At 52 weeks, mean eGFR change from baseline was −0.1 mL/min/1.73 m² with atacicept vs −5.7 mL/min/1.73 m² with placebo, a treatment effect of 5.6. Through 104 weeks, atacicept was associated with a 76% lower risk of a composite kidney disease progression event.  In an interview with HCPLive, ORIGIN 3 investigator Sayna Norouzi, MD, assistant professor of medicine and clinical nephrologist at Loma Linda University Medical Center, discusses the eGFR results. She explains why preserving kidney function is the ultimate treatment goal and how the data speak to the question her patients ask most: whether a therapy can keep them off dialysis or transplant.

"The ultimate goal, and the ultimate question my patients ask, is whether this medication is going to preserve my kidney function," said ORIGIN 3 study investigator Sayna Norouzi, MD, assistant professor of medicine and clinical nephrologist at Loma Linda University Medical Center, director of the Glomerular and Polycystic Kidney Diseases Clinics, and chief education officer of GlomCon, in an interview with 

. "Whenever we talk about kidney disease, patients talk about dialysis or transplant, and this is something they want to prevent."

Through 104 weeks, atacicept was associated with a slower annualized decline in estimated glomerular filtration rate (eGFR) than placebo (−0.6 vs −5.6 mL/min/1.73 m² per year; treatment effect, 5.0; 95% CI, 3.6–6.5; P < .0001) and a 

76% lower risk of a composite kidney disease progression event

 (hazard ratio, 0.24; 95% CI, 0.12–0.48; P < .0001), according to a September 15, 2026, release from Vera Therapeutics.¹,² According to Vera, the eGFR slope aligns with the KDIGO treatment goal of reducing kidney function decline to the physiologic rate (<1 mL/min/1.73 m² per year).¹

ORIGIN 3 trial design: once-weekly atacicept vs placebo in IgAN

ORIGIN 3 (NCT04716231) is a global, multicenter, randomized, double-blind, placebo-controlled phase 3 trial in adults with primary IgAN at risk for disease progression. Participants were randomized 1:1 to self-administered subcutaneous atacicept 150 mg once weekly or placebo for a 104-week double-blind period, followed by a 52-week open-label extension.³

The primary endpoint, change in urine protein to creatinine ratio (UPCR) at 36 weeks, was assessed in an interim analysis and published in 

 to reduce proteinuria in July 2026.⁴ The key secondary endpoint, eGFR change through 104 weeks, was evaluated in the full study population, with 428 patients in the final analysis set.¹

Atacicept stabilized eGFR and prevented dialysis, transplant events at 2 years

At 52 weeks, mean eGFR change from baseline was −0.1 mL/min/1.73 m² (95% CI, −1.4 to 1.2) with atacicept vs −5.7 mL/min/1.73 m² (95% CI, −7.0 to −4.4) with placebo (treatment effect, 5.6; 95% CI, 3.7–7.5; P < .0001).¹

Atacicept met all prespecified endpoints in the final efficacy analysis. Through 104 weeks, 11 patients receiving atacicept experienced a composite kidney disease progression event, compared with 38 patients receiving placebo. No patients receiving atacicept experienced dialysis for ≥30 days, kidney transplantation, or death, compared with 8 patients receiving placebo.¹

"If a medication can show us preservation of kidney function, that's huge for us, and that's huge for patients as well," Norouzi said. "It's one area where there is a lot of alignment between what we want and what our patients want."

Atacicept also achieved statistically significant reductions in the hierarchically tested endpoints of proteinuria, galactose-deficient IgA1 (Gd-IgA1), and hematuria.¹

"Prevention of kidney failure or kidney-related death is the ultimate goal. We now have evidence suggesting that Trutakna may help patients avoid dialysis, transplantation, or kidney-related death over the long term," Richard Lafayette, MD, professor of medicine and director of the Glomerular Disease Center at Stanford University Medical Center and a principal investigator for ORIGIN 3, said in a statement.¹

Atacicept safety: infection rates similar to placebo

Rates of overall adverse events and of infections or infestations were similar between the atacicept and placebo groups. No opportunistic infections or clinically relevant hypogammaglobulinemia occurred.¹ Across clinical trials, the most common adverse reactions with atacicept vs placebo were infections (32% vs 28%) and local administration reactions (30% vs 5%).¹

Supplemental BLA for full approval of atacicept planned for Q4 2026

Vera plans to submit a supplemental Biologics License Application (sBLA) to the FDA in the fourth quarter of 2026, seeking full approval, and will present detailed results at an upcoming scientific congress.¹ Atacicept remains approved under accelerated approval based on proteinuria reduction. Its long-term effect on kidney function decline has not yet been formally established in the label.¹

"The numbers are looking good, and again, it's bringing a lot of hope for us and for patients," Norouzi said.

Vera Therapeutics. Vera Therapeutics announces Trutakna (atacicept-vymj) stabilized eGFR and prevented kidney disease progression through two years in ORIGIN 3 final efficacy analysis in IgA nephropathy. Published September 15, 2026. Accessed September 29, 2026. 

https://ir.veratx.com/news-releases/news-release-details/vera-therapeutics-announces-trutaknatm-atacicept-vymj-stabilized

Hillenbrand A. Atacicept cuts IgAN progression risk 76% in ORIGIN 3 final data. HCPLive. Published September 15, 2026. Accessed September 29, 2026. 

https://www.hcplive.com/view/atacicept-cuts-igan-progression-risk-76-in-origin-3-final-data

Lafayette R, Barbour SJ, Brenner RM, et al. A phase 3 trial of atacicept in patients with IgA nephropathy. 

. 2026;394(7):647-657. doi:10.1056/NEJMoa2510198

Hillenbrand A. FDA approves atacicept (Trutakna) for IgA nephropathy. HCPLive. Published July 7, 2026. Accessed September 29, 2026. 

https://www.hcplive.com/view/fda-approves-atacicept-trutakna-for-iga-nephropathy

Final ORIGIN 3 analysis shows a 76% lower risk of kidney disease progression vs placebo through 2 years.

Atacicept Slows IgAN Decline to Physiologic Rate, With Sayna Norouzi, MD

New Therapeutic Options Raise More Questions for IgA Nephropathy Treatment, With Sayna Norouzi, MD

Evidence shows a continually and rapidly expanding therapeutic landscape for patients with IgA nephropathy (IgAN). Due to the heterogeneity of the disease, clinicians remain undecided about how to approach these options with the IgAN’s complex, individualized presentation.

“It's getting more and more complicated with having more options out there, and we still have ongoing clinical trials, and we recruit for these trials as well. We have to keep in mind that we don't have a cure for IgAN yet, and we're not done with this field,” Norouzi siad. “I think the next step for a lot of our colleagues who are not spending a lot of time with IgAN patients would be a referral to a glomerular disease clinic or center of excellence.”

At WCN, a plethora of data supporting positive progress in IgAN was presented. In a

, Norouzi highlighted the emergence of targeted agents, including targeted-release budesonide, endothelin receptor antagonists like sparsentan and atrasentan, complement inhibitors such as iptacopan, and newer APRIL-targeting therapies. Together, these agents provide clinicians with multiple avenues to reduce proteinuria and preserve kidney function.

“When I go back from every conference that I attend to my clinic, my patients are excited. Sometimes I share with them that I'm going to a conference, and they know when I come back, I'm going to have more data, and they might have more options for their disease. And it's not just about IgAN. We're getting more options for C3G, lupus nephritis,” she concluded. “It's an exciting time to be a nephrologist.”

Norouzi reports relevant disclosures with Calliditas, Travere, Apellis and others.

Norouzi discussed the remaining challenges that come with having evolving treatment options and a robust patient population in IgAN.

Rethinking When and How to Treat IgA Nephropathy, With Sayna Norouzi, MD

The treatment landscape for IgA nephropathy is undergoing a profound transformation, driven by updated clinical guidelines, earlier diagnosis, and a rapidly expanding therapeutic arsenal. Where management was once largely reactive, the field is now moving toward earlier, more aggressive, and more targeted intervention aimed at altering disease trajectory.

 at World Congress of Nephrology in Yokohama, Japan, Sayna Norouzi, MD, a clinical nephrologist and associate professor of medicine at Loma Linda University Medical Center, said one of the most significant shifts between the 2021 and 2025 guidelines is the redefinition of high-risk disease.

Previously, proteinuria thresholds of around 1 gram per day were used to guide treatment escalation. Now, patients with proteinuria ≥0.5 g/day are considered at risk, representing a major change in how clinicians identify and manage disease severity. This lower threshold underscores a growing recognition that IgA nephropathy is not a benign condition and can lead to kidney failure if not addressed early.

“The sooner you diagnose these patients, [the sooner] you're going to be able to treat them, and with effective treatment of IgA nephropathy, you might be able to delay dialysis or transplant or complications in general, for your patients,” she said.

The updated guidelines also emphasize more ambitious treatment goals, with a target proteinuria level ideally < 0.3 g/day. Norouzi explains that this shift reflects mounting evidence linking lower proteinuria to improved long-term outcomes, including delayed progression to dialysis or transplant. As a result, clinicians are now encouraged to pursue tighter disease control from the outset.

Another key evolution lies in treatment strategy. Historically, care began with supportive measures like blood pressure control, lifestyle modification, and initiation of RAAS blockade, with additional therapies introduced only after inadequate response. In contrast, the 2025 guidance promotes a more proactive, simultaneous approach, and while supportive care remains foundational, clinicians are now urged to initiate therapies targeting the underlying pathophysiology earlier in the disease course rather than waiting for treatment failure.

This paradigm shift is enabled by a growing list of therapeutic options. Norouzi highlights the emergence of targeted agents, including targeted-release budesonide, endothelin receptor antagonists like sparsentan and atrasentan, complement inhibitors such as iptacopan, and newer APRIL-targeting therapies. Together, these agents provide clinicians with multiple avenues to reduce proteinuria and preserve kidney function.

Despite this progress, she says important questions remain. Norouzi notes that clinical trials provide only a limited snapshot of efficacy and safety, often over relatively short durations. As these therapies enter real-world practice, she says clinicians will need to better understand long-term tolerability, optimal sequencing, and effectiveness in more heterogeneous patient populations.

“We need more data on these medications, on the safety, on how they are going to work over time. The clinical trials are looking at a limited amount of time. They follow patients for 9 months for the initial outcome data, and then they follow patients for 2 years,” Norouzi said. “Once the medication is FDA approved and it's on the market, that's when we are going to have more information and see in real life if patients are tolerating the medications. We're going to hear more about the side effects, how to monitor these patients over time, and if they are responding well to the medications as well.”

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

Campbell P. Iptacopan Receives Accelerated Approval for Reducing Proteinuria in IgA Nephropathy. August 7, 2024. Accessed April 1, 2026. 

https://www.hcplive.com/view/iptacopan-receives-accelerated-approval-for-reducing-proteinuria-in-iga-nephropathy

Campbell P. Atrasentan (Vanrafia) Receives Accelerated Approval in IgA Nephropathy. April 2, 2025. Accessed April 1, 2026. 

https://www.hcplive.com/view/atrasentan-vanrafia-receives-accelerated-approval-in-igan

New IgAN guidelines emphasize earlier diagnosis, lower proteinuria targets, and combination therapy to delay kidney failure and improve long-term outcomes.

Sayna Norouzi, MD

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