Opinion
Video
Measuring Success in IgA Nephropathy in Clinical Practice
Panelists discuss how treatment success in immunoglobulin A (IgA) nephropathy extends beyond clinical trial end points to encompass sustained proteinuria reduction, stable kidney function, symptom improvement, and enhanced quality of life metrics that matter to patients in real-world settings.
Measuring Treatment Success in IgA Nephropathy: Beyond Clinical Trial End Points
Practical Markers of Treatment Response
Short-term Indicators (3-6 Months)
- Proteinuria reduction: Achievement of ≥ 30% reduction from baseline
- Hematuria improvement: Reduction in red blood cell counts on urinalysis
- Stabilization of estimated glomerular filtration rate (eGFR): Halting or slowing the decline in kidney function
- Resolution of nephrotic features: Improvement in edema, hypoalbuminemia, and hyperlipidemia
- Blood pressure control: Maintenance of targets with stable or reduced medication requirements
Intermediate Indicators (6-24 Months)
- Sustained proteinuria reduction: Maintenance of proteinuria < 1g/day
- eGFR trajectory: Flattening of GFR decline slope compared with pretreatment
- Reduction in gross hematuria episodes: Frequency and severity of macroscopic hematuria events
- Medication tolerance: Ability to maintain therapy without significant adverse effects
- Patient-reported outcomes: Improvement in energy levels, symptom burden, and quality of life measures
Long-term Success Metrics
- Kidney survival: Avoidance of kidney failure requiring kidney replacement therapy
- Hospitalization rates: Reduced kidney-related hospitalizations
- Medication burden: Stability or reduction in total medication requirements
- Functional status: Maintenance of work capacity and daily activities
- Cardiovascular outcomes: Reduced incidence of cardiovascular events
Practical Monitoring Approach
- Individualized surveillance: Tailoring monitoring frequency to disease severity and treatment response
- Composite assessment: Considering multiple parameters rather than single end points
- Trend analysis: Evaluating patterns over time rather than isolated measurements
- Risk reassessment: Periodic recalculation of progression risk based on current clinical status
- Patient-centered outcomes: Including measures that matter most to patients in evaluating success
Limitations of Current Approaches
- Surrogate end point reliability: Imperfect correlation between proteinuria reduction and long-term outcomes
- Biomarker availability: Limited access to specialized biomarkers (galactose-deficient IgA1, autoantibodies) in routine clinical practice
- Heterogeneous disease course: Natural fluctuations in disease activity complicating treatment effect assessment
- Follow-up duration: Need for extended monitoring to capture meaningful outcomes
Integrating these practical measures into routine care allows for more nuanced assessment of treatment success and timely intervention when therapy adjustments are needed.
