Immunoglobulin A nephropathy (IgAN) often leads to a 50% decline in estimated glomerular filtration rate (eFGR) or end-stage kidney disease (ESKD). In fact, the condition is a common cause of kidney failure. To prevent disease progression, the International IgA Nephropathy Network developed an International IgAN Prediction Tool to help predict the risk of a 50% decline in eGFR or ESKD in adults of multiple ethnicities with IgAN. It is available at www.qxmd.com and can be used at the time of a kidney biopsy.

The tool was later updated to detect progression in children and would predict the risk factor of a 30% decline in eGFR or ESKD in the population, after a study validated this data point. 

What Researchers Found

 “All children also saw an improvement in eGFR at some point, but those at higher risk showed only minimal improvement early on and later showed more severe disease progression into early adulthood,” explains Dr. Sean Barbour, a researcher who studied the usability of the predictive tool. This finding helps doctors confirm earlier findings that show children present with some improved kidney function at the beginning of a diagnosis, but that the eGFR should be closely monitored as kidney function decline can quickly progress after this short and misleading period ends. 

In essence, the study’s researchers concluded that:

• Smaller increases in eGFR followed by more rapid declines were associated with a high risk of progression.
• 52 children had a 50% decline in eGFR or ESKD with a 5-year risk of 2.9%.
• 117 children had a 30% decline in eGFR or ESKD, which correlated with a 5-year risk of 9.1%. 

The prediction tool considers that kidney health deterioration should be addressed at a 30% decline in children and 50% in adults. Therefore, the tool is capable of identifying “higher-risk patients along the continuum of nonlinear kidney function decline that spans the full age spectrum of those with IgAN.”

What Will Happen Next?

In the future, the IgA Nephropathy Network hopes to add a new function to the same tool that predicts how patients will respond to immunosuppressive therapy. “Ultimately, the goal is to facilitate personalized treatment decisions based on risk of progression,” explains Dr. Barbour.

*Barbour, S. (2021, August 10). A Welcome Update to the International IgA Nephropathy Prediction Tool. Physician’s Weekly. https://www.physiciansweekly.com/a-welcome-update-to-the-international-iga-nephropathy-prediction-tool