Rethinking IgAN: A Different Perspective from Community Nephrologists : 4

Luis Velez, MD is a board-certified community nephrologist in San Antonio, TX with expertise in hypertension and glomerular disorders.  Jessica Coleman, MD is a board-certified community nephrologist practicing between Savanah, GA and Charleston, SC with expertise in hypertension and glomerular disorders.  In this episode, Drs Velez and Coleman discuss management of IgAN patients from the viewpoint of community nephrologists. They discuss the evolution in their management of IgAN, highlighting the availability of new data such as RaDaR as a key driver of change. With greater awareness of the role of proteinuria, they advocate for early and aggressive treatment to avoid long term complications of IgAN.  Key Quotes: “RaDaR taught me that the traditional way of looking at IgA nephropathy is wrong. We realized this is a disease state that absolutely can progress and can progress more rapidly than what we initially appreciated and certainly at a younger age in these patients. (02:25) “When we look at patients with proteinuria, even just 0.5 g/d, a third of patients under 40 are going to progress to end stage kidney disease in ten years [RaDaR].” (04:30)“With the RaDaR data, we see levels of proteinuria 0.5 -0.8 g/d still being significant markers for disease progression.” (08:56)Key Takeaways:IgAN is not a benign diseaseProteinuria is the most important prognostic indicator of disease progression in IgA NephropathyHCPs should be targeting lower proteinuria goals to achieve complete remission <0.3 g/dThe updated KDIGO Guidelines should support clinicians’ decisions to target complete remission