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.

References

1. Stoneman S, Teh JW, O’Shaughnessy MM. IgA nephropathy in adults. JAMA. Published online January 26, 2026. doi:10.1001/jama.2025.25020

2. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1-S276. doi:10.1016/j.kint.2021.05.021