In a meta-analysis of 53 studies involving 25,517 patients with biopsy-confirmed IgA nephropathy (IgAN), authors identified several clinical factors associated with disease progression. Higher blood pressure, hypertension, proteinuria, serum creatinine, triglycerides, low‐density lipoprotein cholesterol, complement C4, and male sex were associated with greater risk. Higher eGFR, albumin, hemoglobin, and complement C3 were associated with lower risk. Hypertension showed one of the strongest clinical associations with progression (hazard ratio [HR], 2.53), reinforcing the importance of monitoring blood pressure, kidney function, and proteinuria when assessing risk.
Kidney biopsy findings added substantial prognostic information. Oxford classification M, S, T, and more severe C lesions were associated with progression, with tubular atrophy/interstitial fibrosis showing the strongest relationship: T1 lesions were associated with an HR of 4.59 and T2 lesions with an HR of 16.40 compared with T0. However, substantial heterogeneity was present across many analyses, and differences in follow-up, outcome definitions, and study quality limit the certainty and generalizability of some estimates. The findings support combining clinical measures with histopathology rather than relying on any single marker to assess IgAN progression risk.
Reference: Xu D, Zhang M, Liang W, Fang L, Ge F. Risk Factors of Disease Progression in IgA Nephropathy: A Systematic Review and Meta-Analysis. Immun Inflamm Dis. 2026 Feb;14(2):e70393. doi: 10.1002/iid3.70393.
