Overview:

In this episode of the Rare Kidney Disease Show, Professor Jonathan Barratt discusses the need to take a long-term approach when managing IgA nephropathy patients. He presents data from the UK National Registry of Rare Kidney Diseases (RaDaR). During this recording you will hear Professor Barratt discussing the continued risk of progression to end stage renal disease even in patients with proteinuria of less than 1g/day, the current threshold of high risk as per KDIGO guidelines. The data from the UK has been reinforced by recent database studies and these will also be discussed by Professor Barratt.

Key Quotes: 

• "If you have IgA Nephropathy and you're diagnosed as a child, half of those children have developed kidney failure at 20 years."
• "We need to be thinking, what is it like for that patient in front of us being 50 or 60, not necessarily what's going to happen in the next five or ten years."
• "If we don't think the longer term, we're going to under-treat and not serve our patients well." 

Key Takeaways:

• IgA nephropathy patients often have decades of life ahead of them, so physicians should focus on minimizing lifetime risk of kidney failure rather than short-term outcomes (00:02:11)
• RaDaR data shows high rates of kidney failure among IgA nephropathy patients in the UK, even those diagnosed and treated as children (00:04:05)
• Per the RaDaR publication, an eGFR decline of <1 ml/min per 1.73 m2 per year must be the target if patients are to avoid kidney failure (00:06:48)
• In the UK, 1 in 4 IgA nephropathy patients with 0.5-1 g/day proteinuria reach ESRD within 10 years (00:08:23)
• Recent US database searches confirm high rates of CKD progression and kidney failure in IgA nephropathy patients, even those with lower proteinuria levels (00:13:20)