Even Routine Urinalysis Can Reveal Hidden IgAN In Young Patients, With Corey Cavanaugh, DO

Due to IgA nephropathy’s (IgAN) often silent presentation, clinicians should remain vigilant for hypertension and microscopic hematuria during routine evaluations, particularly among younger adults.

“It's not unusual that patients get a life insurance policy evaluation and get screened for hematuria, or they're getting some sort of surgery and a pre-op evaluation. Clinicians should pay close attention to hypertension and microscopic hematuria, especially in young people. Of course, this is a young person's disease,” said Corey Cavanaugh, DO, an academic nephrologist at the Cleveland Clinic, in an interview with HCPLive. “It can be easy to talk away these things, or at least give them a reasonable explanation that isn't IgAN, because they're non-specific features, so it requires a high index of suspicion and an astute clinician for the non-nephrologist, especially.”

The majority of patients with IgAN present with non-visible hematuria, proteinuria, impaired kidney function, or hypertension, features often classified as silent symptoms. A recent study found that approximately 60% of IgAN cases were detected incidentally through hematuria or proteinuria on urinalysis.1

Since many early symptoms are subtle, clinicians often rely on measurable markers to assess disease activity and progression risk. Among these, proteinuria remains one of the most important indicators for identifying patients at greater risk of disease progression and kidney failure.

“The most powerful prognostic clinical indicators are few, actually, but the most powerful one I tend to adhere to is still proteinuria,” said Cavanaugh.

Proteinuria often serves as a key trigger for further diagnostic evaluation. According to the 2025 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for IgAN and IgA Vasculitis (IgAV), clinicians should perform a kidney biopsy to confirm diagnosis in patients with suspected IgAN and persistent proteinuria ≥0.5 g/day.2

Early detection is increasingly important as the therapeutic landscape for IgAN expands. New targeted treatments, including selective corticosteroids, dual endothelin-angiotensin blockers, and emerging complement inhibitors, offer opportunities to slow disease progression and reduce proteinuria.2

Editor’s Note: 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:https://doi.org/10.1001/jama.2025.25020

2. Floege J, Barratt J, Cook HT, et al. Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV). Kidney international. 2025;108(4):548-554. doi:https://doi.org/10.1016/j.kint.2025.04.003