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Defining Disease Modification in IgA Nephropathy: Toward a Paradigm Shift in Management.

Jonathan Barratt1, Laura H Mariani2, Jai Radhakrishnan3

  • 1Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.

Kidney International Reports
|December 22, 2025
PubMed
Summary

Defining disease modification in IgA nephropathy (IgAN) is crucial for developing effective treatments. This review proposes preserving nephrons and avoiding kidney failure as key goals for IgAN interventions.

Keywords:
IgA nephropathydisease modificationglomerular filtration ratekidney failureproteinuriasurrogate end point

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Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • IgA nephropathy (IgAN) is a chronic, immune-mediated kidney disease.
  • It is a leading cause of chronic kidney disease (CKD) and kidney failure.
  • Currently, no cure exists for IgAN, necessitating disease-modifying interventions.

Purpose of the Study:

  • To define "disease modification" in IgA nephropathy.
  • To identify suitable markers for assessing disease modification in IgAN.
  • To discuss a multifaceted approach to IgAN management.

Main Methods:

  • Literature review and conceptual analysis.
  • Examination of potential markers for disease modification assessment.
  • Discussion of therapeutic strategies targeting IgAN pathology and adaptive responses.

Main Results:

  • Disease modification in IgAN should focus on nephron preservation and preventing kidney failure.
  • Meaningful assessment involves evaluating impacts on mortality, kidney failure, eGFR, proteinuria, hematuria, and pathology.
  • A multifaceted management approach is recommended.

Conclusions:

  • Establishing clear definitions and markers for disease modification is essential for IgAN research and treatment.
  • Interventions should aim to preserve kidney function and slow disease progression.
  • Comprehensive management targeting both disease-specific and adaptive processes is key for improving patient outcomes.