The IgAN Treatment Pipeline: Pathogenesis Review
April 8, 2025 • Kidney Disease Content Hub
Sharon Adler, MD, professor of medicine at UCLA and investigator at The Lundquist Institute, explores the pathogenesis of IgA nephropathy, focusing on the four-hit hypothesis. She explains that the disease is driven by the production of under-galactosylated IgA1, which becomes an autoantigen. Subsequent immune complex formation and mesangial deposition lead to inflammation and kidney damage. Clinical and morphological risk factors help assess prognosis, including the MEST-C pathology score. Adler demonstrates how increased proteinuria, even in modest amounts, significantly raises the risk of kidney decline. She discusses the updated risk prediction tools and the evolving treatment landscape, including newer therapies not available during the 2021 KDIGO guideline release.
