A recent perspective argues that the expanding IgA nephropathy (IgAN) treatment landscape may require clinicians to distinguish between therapies that address the disease’s underlying immunologic drivers and those that primarily modify the downstream consequences of nephron loss. The 2025 KDIGO IgAN guideline reflects these parallel treatment tracks, while emerging clinical trial data raise questions about whether similar reductions in proteinuria necessarily translate into equivalent kidney protection. Because proteinuria can reflect both active immune-mediated glomerular injury and residual structural damage, the authors suggest that proteinuria reduction alone may not fully capture true disease modification.
The article highlights a potential shift toward evaluating how proteinuria is reduced, not simply how much it falls. The authors propose reserving the term “disease modification” for therapies that directly target pathogenic IgA production and immune-complex formation. They also emphasize that these concepts remain based on emerging data that require longer follow-up and further validation. Looking ahead, disease-specific biomarkers could become especially important for matching therapies to individual patients and monitoring whether the underlying immunologic process has actually been controlled. However, no IgAN-specific biomarker is currently validated for routine clinical use.
Reference: Barratt J. Disease modification in immunoglobulin A nephropathy. Nephrol Dial Transplant. 2026 Feb 23;41(Suppl 1):i53-i57. doi: 10.1093/ndt/gfaf259.
Link: https://academic.oup.com/ndt/article/41/Supplement_1/i53/8371759?login=true
