Anitha Vijayan, MD, and Kartik Kalra, MD, discuss the role of kidney biopsy in diagnosing and assessing IgA nephropathy (IgAN). Kidney biopsy remains the gold standard because it can directly demonstrate IgA-containing immune-complex deposition in the glomeruli while also showing the extent and type of histologic injury. That information can help clinicians confirm the diagnosis, assess disease severity, estimate prognosis, and inform treatment decisions. At the same time, biopsy is not without limitations. Comorbidities, bleeding risk, and access to experienced nephrology and pathology services can affect whether and when a patient undergoes the procedure.
The discussion also emphasizes that biopsy findings should be considered alongside clinical measures used to determine a patient’s risk of progression. Proteinuria, estimated glomerular filtration rate (eGFR), blood pressure, and histologic scoring can provide important prognostic information and help distinguish patients who may require closer monitoring or more intensive management. Emerging biomarkers and predictive models may further refine this process by providing additional information about disease activity and progression risk. Together, histology, clinical characteristics, and evolving biomarker-based approaches may support a more individualized approach to IgAN risk stratification and treatment.
Reference: Vijayan A, Kalra K. Diagnosis and Risk Stratification in IgA Nephropathy: Biopsy and Biomarkers. AJMC. Published January 8, 2026. Accessed August 20, 2026. https://www.ajmc.com/view/diagnosis-and-risk-stratification-in-iga-nephropathy-biopsy-and-biomarkers
Link: https://www.ajmc.com/view/diagnosis-and-risk-stratification-in-iga-nephropathy-biopsy-and-biomarkers
