Closing Gaps in IgA Nephropathy Diagnosis and Treatment, With Brad Rovin, MD

Despite increased awareness and new treatment options for IgA nephropathy (IgAN), clinicians still face challenges identifying which patients need more than first-line therapy and diagnosing the disease early enough to prevent long-term kidney damage, according to Brad Rovin, MD, professor of nephrology at the Ohio State University Wexner Medical Center.

In an interview with HCPLive, Rovin outlined ongoing challenges in IgAN management, the evolving role of kidney biopsy, and where he sees the field moving over the next several years.

Why RAS Inhibition Alone May Not Be Enough for Many Patients With IgAN

Rovin noted that IgAN is, for most patients, a progressive disease that can ultimately lead to chronic kidney disease (CKD) or end-stage kidney disease, but he suggested this reality is still not widely appreciated across the clinical community. Many clinicians remain comfortable initiating treatment with renin-angiotensin system (RAS) inhibition alone, an approach that has been used for years and has worked for some patients.

“I think most people need something more, because when we see IgA patients in our clinic, they almost all have diminished kidney function,” said Rovin.

He explained that the central challenge is identifying which patients can be adequately managed with RAS inhibition alone and which require additional therapy. Rovin said the field needs to move toward more detailed characterization of individual patients early in the course of care to identify those who may need minimal intervention and, more importantly, flag those who likely require more intensive treatment. He emphasized that knowing which patients need additional therapy upfront is vitally important.

Pathology Could Expand the Role of Kidney Biopsy in IgAN

Rovin described himself as strongly in favor of biopsy-based diagnosis, noting that tissue analysis remains central to understanding IgAN. He pointed to ongoing work in nephropathology examining the molecular underpinnings of the disease, with an eventual goal of translating molecular-level findings into clinically actionable information without delaying diagnosis or treatment, since transcriptomic and proteomic analyses remain time-intensive.

He also highlighted an emerging area of pathology known as pathomics, which applies machine learning to examine structural features in kidney tissue that may be difficult to assess visually, such as basement membrane thickness or podocyte architecture within the glomeruli. According to Rovin, these features may eventually help predict treatment response or disease progression, further expanding the clinical utility of biopsy in IgAN.

Therapies Targeting B-Cell Pathways Could Gain Ground in IgAN

Rovin's comments come as 2 therapies targeting pathways involved in B-cell function have become available for IgAN: sibeprenlimab (Voyxact), approved in November 2025, and atacicept (Trutakna), which received FDA accelerated approval on July 7, 2026, to reduce proteinuria in adults with primary IgAN at risk for disease progression.1,2

Rovin said these newer therapies could see increased use now that 2 such agents are approved, and he believes they could provide meaningful benefit for patients with IgAN.

He noted some clinician reluctance to consider therapies that target B-cell pathways in IgAN, saying some nephrologists may be less familiar with modifying B-cell function in this setting despite using similar approaches in diseases such as lupus nephritis.

“They would have no second thoughts about doing it for a lupus patient,” said Rovin, adding that education about these therapies and their potential role in IgAN will be important as their use expands.

Earlier Referral Could Improve Long-Term IgAN Outcomes

Looking ahead, Rovin said his primary hope for the field is earlier diagnosis. He pointed to the need for closer collaboration between nephrology, primary care, and urology to ensure that patients presenting with mild hematuria or proteinuria are referred for further evaluation rather than having those findings attributed to a urinary tract infection or another cause.

“I think that will get us to where we want to be, because earlier therapy is beneficial for most people,” said Rovin.

Editor’s Note: Rovin reports relevant disclosures with AstraZeneca, Aurinia Pharmaceuticals, Biogen, Eli Lilly and Company, GlaxoSmithKline (GSK), Genentech/Roche, Pfizer, Novartis, and others.

References

1. Iapoce C. FDA approves atacicept for IgA nephropathy. AJMC. August 2026. Accessed August 11, 2026. https://www.ajmc.com/view/fda-approves-atacicept-for-iga-nephropathy

2. A second B cell drug for IgA nephropathy was approved in July and two more FDA decisions are due by December. Medical Daily. July 2026. Accessed August 11, 2026. https://www.medicaldaily.com/iga-nephropathy-atacicept-approval-fda-decisions-2026-476696