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Long-Term Outcomes in IgA Nephropathy.

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IgA nephropathy often leads to kidney failure, with most patients progressing within 10-15 years. Early risk assessment using proteinuria and eGFR slope is crucial for managing IgA nephropathy and developing new treatments.

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Area of Science:

  • Nephrology
  • Immunology
  • Epidemiology

Background:

  • Immunoglobulin A (IgA) nephropathy is a leading cause of chronic kidney disease.
  • Progression to kidney failure necessitates improved risk stratification and therapeutic strategies.
  • Early assessment of disease trajectory is vital for patient management and drug development.

Purpose of the Study:

  • To investigate the relationship between proteinuria, estimated glomerular filtration rate (eGFR) slope, and lifetime risk of kidney failure in IgA nephropathy.
  • To identify key predictors of kidney failure progression in a large, real-world cohort.
  • To inform clinical decision-making and therapeutic target identification.

Main Methods:

  • Analysis of a large IgA nephropathy cohort (n=2439) from the UK National Registry of Rare Kidney Diseases (RaDaR).
  • Inclusion criteria: biopsy-proven IgA nephropathy with proteinuria >0.5 g/d or eGFR <60 ml/min/1.73 m².
  • Kidney survival analyzed using Kaplan-Meier and Cox regression; eGFR slope estimated via linear mixed models.

Main Results:

  • Median follow-up was 5.9 years; 50% of patients reached kidney failure or died.
  • Median kidney survival was 11.4 years, with a mean age at kidney failure/death of 48 years.
  • Time-averaged proteinuria significantly correlated with worse kidney survival and faster eGFR decline; even proteinuria <0.88 g/g indicated high risk.

Conclusions:

  • Outcomes in IgA nephropathy are generally poor, with most patients facing kidney failure.
  • Patients with proteinuria <0.88 g/g, often considered low-risk, exhibited substantial rates of kidney failure within 10 years.
  • Risk assessment incorporating proteinuria and eGFR slope is essential for predicting IgA nephropathy progression.