Assessing Long-Term Renal Outcomes and Kidney Failure Risk Reduction in IgA Nephropathy

In the final episode, Assessing Long-Term Renal Outcomes and Kidney Failure Risk Reduction in IgA Nephropathy, the panelists explored the following critical questions:

What is the impact of therapy on long-term progression to kidney failure or dialysis?

How have the KDIGO thresholds from proteinuria changed based on clinical trial data?

Led by Dr. Appel, Dr. Sanchez Russo examined therapeutic advances in IgA nephropathy that have increasingly demonstrated meaningful effects on long-term kidney outcomes by slowing disease progression and reducing the risk of kidney failure or dialysis. Clinical trial and real-world data show that sustained reductions in proteinuria are strongly associated with preservation of eGFR and improved long-term renal survival, reinforcing proteinuria as a validated surrogate endpoint. As a result, effective therapies that achieve durable proteinuria lowering are now viewed as disease-modifying rather than purely supportive. KDIGO thresholds for intervention have evolved in response to these data, with greater emphasis on earlier treatment for patients with persistent proteinuria despite optimized supportive care. Rather than reserving escalation for very high proteinuria levels, newer guidance supports intervention at lower thresholds when proteinuria remains ≥0.5 g/day and kidney function is at risk. This shift ref

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

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