Gaps in IgAN Care: Early Detection, Screening, and Referral

This episode, "Gaps in IgAN Care: Early Detection, Screening, and Referral," turns to the practical barriers that delay diagnosis.

Dr. Fervenza names a core gap: IgA nephropathy feels common to glomerular specialists but is rare in general practice. He illustrates this with a fellow from a distinguished New York institution. After two weeks in his clinic, she said she had seen more glomerulonephritis than in her entire prior fellowship. Dr. Fervenza explains that most graduating fellows enter community dialysis-focused practice with little outpatient glomerular exposure. He argues the new therapeutic armamentarium requires knowing how and when to use each agent, which demands education. Dr. Mehdi picks up the theme of heterogeneity, noting one patient may stay stable for decades while another progresses rapidly. He stresses that clinicians must see enough volume to navigate these cases and identify who is high risk. He then focuses on asymptomatic hematuria, which US clinicians often recognize late, after patients reach CKD stage 3 or 4. The panel supports developing glomerular disease centers of excellence for state-of-the-art care. They argue education must extend to the entry points of the medical system. He names primary care, family practice, urologists, and OB-GYNs, who often serve as PCPs for young women. Dr. Rovin contrasts this with Asian countries that screen and catch the disease earlier, with a different phenotype. He champions the basic urinalysis as the cheapest available test, yet one rarely performed at routine visits. Dr. Mehdi describes the risk-stratification challenge once patients finally arrive. He notes microscopic hematuria with low-grade proteinuria is far more common than the classic synpharyngitic presentation. The panel agrees a high index of suspicion and regular follow-up are essential, since hematuria attributed to UTIs often deserves deeper investigation.

Our next episode, "When to Biopsy in IgAN: Presentation, Thresholds, and Monitoring," turns to Dr. Mehdi and Dr. Fervenza on when clinical presentation should prompt a kidney biopsy.