Dr. Parikh describes moving toward disease modification and remission rather than merely slowing progression. Dr. Rovin agrees the field is not at a cure but believes it can profoundly slow or stop progression. For him, the enduring goal has always been keeping patients off renal replacement therapy. He frames IgA nephropathy care as a long-term relationship focused on stable kidney function. Dr. Parikh then asks Dr. Fervenza how patient-centered outcomes fit into management. Dr. Fervenza reiterates that his goal is stabilizing or improving GFR. He argues this is achievable only by eliminating inflammation in patients who present with an inflammatory manifestation of blood and protein in the urine. If inflammation persists, he warns, the disease will progress and long-term damage follows. He points again to Dr. Rovin's forthcoming ASN data showing damage even in seemingly benign biopsies. He argues studies like RaDaR reflect poorly managed, undertreated patients across countries. Treating the inflammatory component, he insists, is the key, because this is a glomerulonephritis. Dr. Parikh adds a major quality-of-life shift enabled by newer therapies. Clinicians can now largely avoid systemic corticosteroids, except in a small RPGN population. Dr. Mehdi emphasizes the comorbidity and burden of long-term steroid use, especially cosmetic side effects in a young population. Because IgA nephropathy is largely confined to the kidney, he notes, patients lack the systemic manifestations seen in vasculitis or lupus. But anxiety is significant, particularly when patients present with hematuria. He stresses that many patient-reported outcomes in IgA nephropathy stem directly from corticosteroid exposure, making steroid-sparing therapy an important advance to discuss with patients.

Our final episode, "Shared Decision Making and the Future of IgAN Therapy," turns to shared decision making and the therapies the panel is most excited to see mature.