Chee Kay Cheung, MBChB, PhD

KDIGO updates in IgA nephropathy highlight lower proteinuria targets, improved risk tools, and an expanding landscape of targeted and combination therapies.

In the closing discussion, the panel looks ahead to how IgA nephropathy treatment may continue to evolve.

This episode focuses on translating clinical evidence into everyday treatment decisions.

The KDIGO 2025 guidelines update emphasizes a more aggressive approach to treating IgA Nephropathy.

In this segment, the panel focuses on clarifying terminology and discussing evolving treatment strategies for IgA nephropathy.

In this segment, the panel discusses how B-cell modulators such as atacicept, sibeprenlimab, and povetacicept may fit within evolving treatment pathways for IgA nephropathy.

In this segment, the panel discusses how monitoring strategies will need to adapt as B-cell–targeted therapies such as atacicept, sibeprenlimab, and povetacicept move into broader clinical use.

In this segment, the panel reviews the emerging clinical data for two additional BAFF/APRIL–pathway inhibitors: sibeprenlimab and povetacicept.

This segment centers on the clinical development of atacicept, a BAFF/APRIL–pathway inhibitor designed to reduce the upstream production of galactose-deficient IgA1.

In this segment, the panel compares different disease-modifying therapeutic strategies under investigation for IgA nephropathy.

In this segment, the panel discusses how the treatment landscape for IgA nephropathy is evolving with the introduction of disease-targeted therapies.

The panel examines drug classes targeting the BAFF and APRIL pathways, which play key roles in the production and regulation of IgA-secreting plasma cells.

This episode focuses on the underlying biology of IgA nephropathy, particularly the “multi-hit hypothesis.”

In this segment, the panel focuses on what “optimized supportive care” truly means for patients with IgA nephropathy.

The panel discusses how clinicians assess progression in IgA nephropathy and the importance of recognizing high-risk patients early. They emphasize that proteinuria is a central prognostic marker, and that achieving sustained reduction is critical. However, they note that ongoing eGFR decline, even when proteinuria appears improved, signals continued immune-mediated injury and should prompt re-evaluation. The group then addresses diagnostic challenges, including the fact that many patients first present after significant kidney damage has already occurred. To improve early detection, they support lowering the biopsy threshold to persistent proteinuria around 0.5 g/day, particularly when accompanied by hematuria. Increased awareness among primary care clinicians is highlighted as essential for earlier referral. Finally, the discussion includes the role of the RaDaR Registry, which collects long-term real-world data to help identify progression patterns and refine risk stratification. Overall, the segment underscores the need for early diagnosis and vigilant monitoring.

In this segment, the panelists discuss IgA Nephropathy, a glomerular disease primarily affecting young adults in their 20s and 30s. The condition has a slight predilection for males and Southeast Asians. Patients typically present asymptomatically with blood or protein in urine, or with gross hematuria following a respiratory tract infection. Less commonly, patients may develop severe nephrotic syndrome. Clinicians are most concerned with proteinuria and kidney function. Patients with proteinuria exceeding 0.5 grams are considered at risk for disease progression. The panel emphasizes that diagnoses often occur too late, with patients already having lost nearly half their kidney function. This is particularly critical because these young patients have decades ahead of them, and even small annual kidney function losses can lead to end-stage kidney disease, potentially requiring dialysis. The early detection and monitoring of these patients are crucial for preserving long-term kidney health.

Cheung explores the effect of sparsentan on urinary biomarkers in treatment-naive patients with IgA nephropathy.