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Baseline Assessment at Biopsy

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Sarah, 25

Sarah, 25

Baseline Assessment at Biopsy

Age

25

Race

Asian (Japanese)

eGFR

70 mL/min/1.73 m2

Systolic BP

130 mm Hg

Diastolic BP

80 mm Hg

Proteinuria

2.1 g/d

Use of ACE Inhibitor
or ARB at biopsy

None

MEST M-score

1

MEST E-score

0

MEST S-score

0

MEST T-score

0

MEST C-score

0

Immunosuppression use

None

PAS staining of M1 positive lesion.

PAS staining of M1 positive lesion.*

*Image used with permission from the Renal Fellow Network, from Gallan A. Kidney Biopsy of the Month. Published July 29, 2019. Available at: Kidney Biopsy of the Month: IgA Nephropathy - Renal Fellow Network/.

ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; BP, blood pressure; eGFR, estimated glomerular filtration rate; HPF, high-power field; MEST-C, mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), tubular atrophy and interstitial fibrosis (T), crescent (C); PAS, periodic acid-Schiff; RBC, red blood cells; UPCR, urine protein creatinine ratio.

Sarah, 25

Baseline Assessment at Biopsy

Age

25

Race

Asian (Japanese)

eGFR

70 mL/min/1.73 m2

Systolic BP

130 mm Hg

Diastolic BP

80 mm Hg

Proteinuria

2.1 g/d

Use of ACE Inhibitor
or ARB at biopsy

None

MEST M-score

1

MEST E-score

0

MEST S-score

0

MEST T-score

0

MEST C-score

0

Immunosuppression use

None

PAS staining of M1 positive lesion.

PAS staining of M1 positive lesion.*

Sarah, 25

Sarah is a 25-year-old Japanese American woman and recent law school graduate. She began working at a local, fast-paced law firm 6 months prior to her initial exam.

Sarah has been experiencing dark brown urine for the past 2 days following an upper respiratory tract infection. She is currently not menstruating and recalled a similar incident when she was a teenager.

  • No remarkable findings upon physical exam
  • Her urinalysis showed >25 RBC/HPF and 2+ protein

Sarah was referred to a nephrologist for subsequent workups:

UPCR 2.1 g/g (~24-hour urine
protein excretion of 2.1 g/d)

Kidney biopsy revealed dominant IgA staining and evidence of mesangial hypercellularity, which confirmed Sarah’s IgAN diagnosis

Click the arrows in the carousel below to explore Sarah’s baseline characteristics

Swipe in the carousel below to explore Sarah’s baseline characteristics

*Image used with permission from the Renal Fellow Network, from Gallan A. Kidney Biopsy of the Month. Published July 29, 2019. Available at: https://www.renalfellow.org/2019/07/29/kidney-biopsy-of-the-month-iga-nephropathy/.

ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; BP, blood pressure; eGFR, estimated glomerular filtration rate; HPF, high-power field; MEST-C, mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), tubular atrophy and interstitial fibrosis (T), crescent (C); PAS, periodic acid-Schiff; RBC, red blood cells; UPCR, urine protein creatinine ratio.

Baseline Assessment trigger button

Sarah’s Risk of Progression

After Sarah’s IgAN diagnosis was confirmed by biopsy, she was prescribed an ACEi/ARB. One year later, her proteinuria stabilized to 1 g/d and her blood pressure was lowered to 120/80 with supportive care and lifestyle modifications.

Graph showing Sarah's risk of progression one year after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 27. 5 percent risk one year after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 28. 11 percent risk two years after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 29. 18 percent risk three years after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 30. 25 percent risk four years after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 31. 33 percent risk five years after stabilization on optimized supportive care
Graph showing Sarah's risk of progression one year after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 27. 5 percent risk one year after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 28. 11 percent risk two years after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 29. 18 percent risk three years after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 30. 25 percent risk four years after stabilization on optimized supportive care Graph showing Sarah's risk of progression at age 31. 33 percent risk five years after stabilization on optimized supportive care

View the International
IgAN Prediction Tool

External link icon

Current KDIGO guidelines do not recommend SGLT2i use in IgAN in the absence of diabetes, as additional data are needed to assess efficacy and safety. Treatments in hypothetical patient cases reflect current treatment guidelines.2

aPredicted risk of progression was calculated using the International IgAN Prediction Tool and defined as the risk of a 50% decline in eGFR or ESKD.1

ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; KDIGO, Kidney Disease: Improving Global Outcomes; SGLT2i, Sodium-Glucose Transport Protein 2 inhibitor.

References: 1. Barbour SJ, et al. Kidney Int. 2022;102(1):160-172. 2. KDIGO. Kidney Int. 2021;100:S1-S276.

Impact of Proteinuria

Despite decreasing her proteinuria level by half to 1 g/d,
Sarah remains at risk of progression.

A retrospective cohort study showed that patients perceived as low risk continue to remain at risk of progression to kidney failure within 10 years2

  • 30% risk in patients with proteinuria 0.5 to 1 g/d
  • ~20% risk in patients with proteinuria <0.5 g/d

Use the slider to see how reducing proteinuria below 1 g/d could reduce Sarah’s risk of progression.

23 percent risk progression at 5 years with proteinuria at 0.5 g/d 28 percent risk progression at 5 years with proteinuria at 0.75 g/d 33 percent risk progression at 5 years with proteinuria at 1 g/d

Reducing proteinuria from 1 g/d to 0.5 g/d lowers the risk of progression by ~10%

Slider shown at 0.5 g/d Slider shown at 0.75 g/d Slider shown at 1.0 g/d

aPredicted risk of progression was calculated using the International IgAN Prediction Tool and defined as the risk of a 50% decline in eGFR or ESKD.

eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease.

References: 1. Barbour SJ, et al. Kidney Int. 2022;102(1):160-172. 2. Pitcher D, et al. Clin J Am Soc Nephrol. 2023;18(6):727-738.

Changes in Proteinuria
and eGFR Over Time

Through medication and lifestyle changes, Sarah may be able to reduce her proteinuria and slow her eGFR decline.

Changes in proteinuria and eGFR over time

Use the slider to see how Sarah’s proteinuria and eGFR may change over time

Graph modeling proteinuria progression over time with and without intervention, starting at biopsy Graph showing proteinuria level with and without intervention, after two years Graph showing proteinuria progression with and without intervention, at four years Graph showing proteinuria with and without intervention, at six years
Graph modeling proteinuria progression over time with and without intervention, starting at biopsy Graph showing proteinuria level with and without intervention, after two years Graph showing proteinuria progression with and without intervention, at four years Graph showing proteinuria with and without intervention, at six years
Graph modeling eGFR decline over time with and without intervention, starting at biopsy Graph showing eGFR with and without intervention, after two years Graph showing eGFR with and without intervention, after four years Graph showing eGFR with and without intervention, after six years
Graph modeling eGFR decline over time with and without intervention, starting at biopsy Graph showing eGFR with and without intervention, after two years Graph showing eGFR with and without intervention, after four years Graph showing eGFR with and without intervention, after six years
Slider shown at biopsy stage Slider shown at 2 years Slider shown at 4 years Slider shown at 6 years
Slider shown at biopsy stage Slider shown at 2 years Slider shown at 4 years Slider shown at 6 years

Changes in proteinuria and eGFR, as well as the differences between "With intervention" and "Without intervention", are hypothetical and based on trends seen in clinical trials and cohort studies.1-4

eGFR, estimated glomerular filtration rate.

References: 1. Pitcher D, et al. Clin J Am Soc Nephrol. 2023;18(6):727-738. 2. Faucon AL, et al. Nephrol Dial Transplant. 2024;30:gfae085. 3. Rovin BH, et al. Lancet. 2023;402(10417):2077-2090. 4. Lafayette R, et al. Lancet. 2023;402:859-870.

Impact of eGFR Decline on
Progression to Kidney Failure

If Sarah’s eGFR decline stabilizes, this can delay the onset of kidney failure.

Select a button below to see how different rates of eGFR decline can impact progression to kidney failure.

Graph depicting changes in eGFR over time Graph depicting changes in eGFR over time at a loss of 2 mL/min/1.73 m2 per year Graph depicting changes in eGFR over time at a loss of 3 mL/min/1.73 m2 per year Graph depicting changes in eGFR over time at a loss of 5 mL/min/1.73 m2 per year
Graph depicting changes in eGFR over time Graph depicting changes in eGFR over time at a loss of 2 mL/min/1.73 m2 per year Graph depicting changes in eGFR over time at a loss of 3 mL/min/1.73 m2 per year Graph depicting changes in eGFR over time at a loss of 5 mL/min/1.73 m2 per year

CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.

A Considerable Impact on Physical, Mental, and Emotional Health1,2

~25% of patients with IgAN experience anxiety1,a

~30% of patients with IgAN experience depression2,b

~40% daily activity impairment reported3,c

Up to 40% overall work impairment reported3,c

aSurvey of U.S. patients on coping with IgAN from the NKF Voice of the Patient Report.

bProspective observational study of adult patients with biopsy-confirmed IgAN.

cBased on real-world data from the Adelphi IgAN Disease Specific Programme (DSP), a point-in-time survey of IgAN-treating nephrologists and their patients in the United States, EU5 (France, Germany, Italy, Spain, and the United Kingdom), Japan, and China between June and October 2021. Data presented are for patients with IgAN in the United States, and are based on the average impairment reported by participants.

References: 1. The Voice of the Patient. National Kidney Foundation. December 8, 2020. Accessed June 10, 2024. https://www.igan.org/wp-content/uploads/2021/01/VOP_IgAN_12-7-20__FNL.pdf. 2. Zhao Y, et al. J Int Med Res. 2020;48(1):300060519898008. 3. Lafayette R, et al. Poster. International Symposium on IgA Nephropathy; Tokyo, Japan. September 28-30, 2023 (poster P-51).

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