Challenges in Timely Identification of IgA Nephropathy

EP: 1.Advancing IgA Nephropathy Care: Emerging Therapies, Unmet Needs, and Economic Considerations

EP: 2.Introduction to IgA Nephropathy

EP: 3.Pathogenesis of IgA Nephropathy: The 4-Hit Cascade, A Proliferation-Inducing Ligand (APRIL), and cytokines

EP: 4.Diagnosing IgA Nephropathy

EP: 5.Signs and Symptoms of IgA Nephropathy

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EP: 6.Challenges in Timely Identification of IgA Nephropathy

Impact of Diagnostic Challenges on Timely Management of IgA Nephropathy

Delays in Diagnosis

• Asymptomatic nature: Many patients with microscopic hematuria and mild proteinuria remain undetected until routine screening or development of complications
• Misattribution of symptoms: Episodes of gross hematuria often misdiagnosed as urinary tract infections or nephrolithiasis, leading to inappropriate antibiotic treatment or imaging studies
• Watchful waiting approach: Clinicians may observe isolated hematuria for extended periods before pursuing biopsy, allowing silent progression
• Biopsy hesitancy: Reluctance to perform invasive procedures in patients with seemingly mild presentations delays definitive diagnosis

Consequences of Delayed Diagnosis

• Disease progression: Undiagnosed patients may develop irreversible kidney damage during the diagnostic delay period
• Missed therapeutic window: Optimal timing for intervention may be lost, particularly for patients who would benefit from early immunosuppression
• Accumulation of kidney scarring: Ongoing inflammation leads to glomerulosclerosis and tubulointerstitial fibrosis before treatment initiation
• Development of hypertension: Uncontrolled blood pressure further accelerates kidney damage

Treatment Initiation Challenges

• Risk stratification difficulty: Without established biomarkers, clinicians struggle to identify which patients require aggressive therapy vs conservative management
• Treatment individualization: Heterogeneous disease presentations complicate the development of standardized treatment algorithms
• Therapeutic uncertainty: Lack of pathognomonic biomarkers creates uncertainty about treatment efficacy monitoring
• Patient acceptance: Delayed diagnosis may reduce patient adherence to therapy or follow-up, particularly in asymptomatic individuals

Clinical Practice Implications

• Geographic disparities: Variable access to nephrology expertise and kidney biopsy services creates inequities in timely diagnosis
• Resource limitations: Renal biopsy requirements strain health care systems in resource-limited settings
• Follow-up challenges: Patients with mild disease may be lost to follow-up due to perceived benignity, missing opportunities for early intervention
• Clinical inertia: Transition from observation to active treatment often delayed due to uncertain progression risk

Early identification remains critical as emerging evidence suggests that timely intervention, including renin-angiotensin-aldosterone system blockade, supportive care, and selected immunomodulatory therapies in high-risk patients, may significantly improve long-term outcomes in IgA nephropathy.