"Most people need something more,” Brad Rovin, MD, professor of nephrology at the Ohio State University Wexner Medical Center, said in an interview with HCPLive, describing where IgA nephropathy (IgAN) treatment stands today, even with a wave of new therapies on the market, including why so many patients are still undertreated, what he expects from the future of kidney biopsy, and where he thinks the field is dropping the ball on diagnosis.

Q&A: What's Still Missing in IgA Nephropathy Care, With Brad Rovin, MD

HCPLive: Despite increased awareness and new treatment options, what challenges or misconceptions about IgAN management do you think still need to be addressed?

Rovin: A lot of the community still doesn't really appreciate that this disease is, in most patients, progressive, and ultimately, over a long span, will result in chronic kidney disease or end stage kidney disease. Folks are still content to start therapy with simply RAS inhibition, despite the plethora of new approaches available, because it's worked in the past for some people. The real problem is we don't know who needs only that therapy and who needs something more. My opinion is that most people need something more, because when we see IgA patients in our clinic, they almost all have diminished kidney function. So I don't think RAS inhibition alone is enough. We need to start very much characterizing our patients, and hopefully we'll learn who can get away with very little therapy, but the majority really will need something else. Knowing that upfront, when you start working with a patient, is vitally important.

HCPLive: Kidney biopsy remains central to the diagnosis of IgAN. As our understanding of disease biology evolves, how do you see the role of pathology changing in guiding prognosis and treatment decisions?

Rovin: I am very much a biopsy in favor person. I think we can learn a lot from the tissue. We have ways to go in IgAN, but a lot of what we're doing now in nephropathology is looking at the molecular underpinnings of disease. Eventually we'll have to understand how to translate what's going on at the molecular level in tissue into something that can be utilized clinically right away, because doing transcriptomics and proteomics on tissue takes time, and you don't want to delay diagnosis or treatment. This is where we're going in the pathology space. Another newish field of pathology is called pathomics, which is really exciting. It uses machine learning to look at all the little things in the pathology and structure of the kidney that we can't see with our eye, like the thickness of a basement membrane or how the podocytes are laying in the glomeruli. These may also influence results of therapy or how the kidney progresses over time. There's a lot happening now in pathology that will increase the utility of the biopsy in the future.

HCPLive: Are there any treatment approaches or strategies in IgAN that you think are currently underappreciated in clinical practice or deserve more attention from clinicians?

Rovin: I think the rollout has been sort of the first line therapies that got approved a couple years ago, and I don't know that they're underappreciated. I do think the exciting new therapies are the drugs targeting B cells, and again, I don't think they're underappreciated, but we have to educate people well on their potential. A lot of people are reluctant to think about them, maybe because they're not used to depleting or modifying B cell function, and they're worried about that for IgAN. But they would have no second thoughts about doing it for a lupus patient. So there's some education needed there. I do think these therapies are going to have a big uptick now that there are two approved,1,2 and I think they'll really benefit our patient population.

HCPLive: What is one change you hope to see in IgAN care over the next few years?

Rovin: I would like to see us being able to make the diagnosis much sooner than we have been doing. I think that's going to take the nephrology community working with primary care physicians and our urology colleagues to refer patients who have a little bit of blood in their urine, a little bit of protein, earlier than they do, and not dismiss those clinical findings as urinary tract infections or something else. I think that will get us to where we want to be, because earlier therapy is beneficial for most people.

References

1. Iapoce C. FDA approves atacicept for IgA nephropathy. AJMC. August 2026. Accessed August 11, 2026. https://www.ajmc.com/view/fda-approves-atacicept-for-iga-nephropathy

2. A second B cell drug for IgA nephropathy was approved in July and two more FDA decisions are due by December. Medical Daily. July 2026. Accessed August 11, 2026. https://www.medicaldaily.com/iga-nephropathy-atacicept-approval-fda-decisions-2026-476696