Diagnosis and Risk Stratification in IgA Nephropathy: Biopsy and Biomarkers

A kidney biopsy remains the gold standard for diagnosing IgA nephropathy (IgAN), as it directly demonstrates IgA-containing immune complex deposition in the glomeruli and allows assessment of histologic severity. Biopsy is critical not only for diagnosis but also for guiding prognosis and treatment decisions. However, practical challenges exist, including patient comorbidities, bleeding risk, and access to specialized pathology services, which can limit timely diagnosis. To complement histology, clinical tools and biomarkers are increasingly used to stratify risk and guide management. Parameters such as proteinuria, estimated glomerular filtration rate (eGFR), blood pressure, and histologic scoring systems provide prognostic insight. Emerging biomarkers and predictive models are refining risk assessment, helping clinicians identify patients at higher risk of progression and tailor therapy accordingly, ultimately supporting more personalized care in IgAN.