IgAN Progression Risk: Proteinuria, eGFR Decline, and the Role of Hematuria

Welcome back to another HCPLive Peer Exchange series. In "IgAN Progression Risk: Proteinuria, eGFR Decline, and the Role of Hematuria," moderator Shikha Wadhwani, MD, MS, FASN is joined by Chee Kay Cheung, MBChB, MRCP, PhD, FHEA and Abdallah S. Geara, MD to open the series on IgA nephropathy.

Dr. Wadhwani welcomes viewers, introduces the panel, and previews the discussion before asking Dr. Geara how much risk of kidney failure remains despite recent therapeutic advances. Dr. Geara describes IgAN as a progressive chronic kidney disease that leads to dialysis in the majority of patients. He notes that the disease affects every race and ethnicity, although patients of East Asian ancestry tend to present younger with more progressive disease. Age at onset and eGFR at presentation are additional risk markers. Dr. Cheung adds that proteinuria and eGFR decline are the two key variables, with proteinuria standing out as the main modifiable risk factor. Dr. Cheung cites the recent KDIGO guidance, which targets proteinuria below 0.5 grams per day and an eGFR decline under 1 mL/min per year, matching physiologic aging.

Dr. Wadhwani recalls that a goal of less than 1 gram per day once seemed sufficient, and that registry data, including the UK RADAR registry, have changed that thinking. Dr. Cheung explains that proteinuria can be measured accurately in clinic, whereas eGFR trajectory needs many data points over a longer period, so early proteinuria response guides judgment about a new treatment. The panel then debates hematuria. Dr. Cheung considers proteinuria and eGFR decline far better validated, notes that isolated hematuria with stable function carries a good outlook, and observes that therapies can now reduce hematuria. Dr. Geara agrees that hematuria is not uniform across patients. He treats its disappearance on targeted therapy, and its return after stopping, as a sign of recurring inflammation, interpreted patient by patient.

The next episode in this series, "IgAN Treatment Escalation: Beyond Supportive Care and Access Barriers,"features the panel weighing when supportive care alone falls short and what ambitious goals now look like.