Abstract: SA-PO0765
Expert Consensus on the Likelihood and Treatment of Inflammatory and Fibrotic IgAN
Session Information
- Glomerular Research: Design, Registries, Surveys, and Epidemiology
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Radhakrishnan, Jai, Columbia University, New York, New York, United States
- Anand, Sanjiv, Intermountain Health, Salt Lake City, Utah, United States
- Haas, Mark, Cedars-Sinai, Los Angeles, California, United States
- Herlitz, Leal C., Cleveland Clinic, Cleveland, Ohio, United States
- Lafayette, Richard A., Stanford University, Stanford, California, United States
- Li, Tingting, Washington University in St Louis, St. Louis, Missouri, United States
- Madan, Arvind, Central Florida Kidney Specialists, Orlando, Florida, United States
- Mehdi, Ali, Cleveland Clinic, Cleveland, Ohio, United States
- Norouzi, Sayna, Loma Linda University, Loma Linda, California, United States
- Rovin, Brad, The Ohio State University, Columbus, Ohio, United States
- Wadhwani, Shikha, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Campos, Cynthia, ADVI Health, Washington, New York, United States
- Weiss, Justin, ADVI Health, Washington, New York, United States
- Broder, Michael S., ADVI Health, Washington, New York, United States
- Yermilov, Irina, ADVI Health, Washington, New York, United States
Background
Immunoglobulin A nephropathy (IgAN) presents variably from asymptomatic hematuria to kidney failure. Histopathology can demonstrate predominantly inflammatory lesions, fibrosis/sclerosis, or a combination of both features. We aimed to characterize inflammatory and fibrotic phenotypes of IgAN and develop expert guidance on treatment.
Methods
We employed the RAND/UCLA modified Delphi method, a validated approach to reach consensus. A panel of 9 nephrologists and 2 renal pathologists from geographically diverse US institutions reviewed clinical and histological parameters and rated 396 hypothetical patient scenarios. Scenarios varied by histologic findings (inflammatory, fibrotic, or mixed), biopsy timing relative to treatment decision (<3 months or at 12 months), hematuria status (present, absent), proteinuria grade (low, moderate, or high), and eGFR trajectory (stable, decreasing). Each scenario included ≥1 FDA-approved treatment strategies (Figure 1). Panelists rated scenarios on a 1-9 scale before and after an in-person meeting. Disagreement was defined as ≥2 ratings of 1-3 and ≥2 ratings of 7-9 within the same scenario.
Results
Consensus on phenotype and treatment recommendations are summarized in Figure 1. Panelists disagreed on 8% of ratings following the meeting, compared to 34% prior. Disagreement was present around the use of endothelin receptor antagonist (ERA)-based therapies alone for patients with exclusively inflammatory lesions, as well as for those with mixed lesions and decreasing eGFR.
Conclusion
This expert panel characterized inflammatory and fibrotic phenotypes of IgAN and developed treatment guidance informed by widely available biomarkers and histologic features. These findings offer a structured strategy to guide therapeutic decision-making and address a significant gap in the current management of IgAN, within the context of an evolving therapeutic landscape.
Funding
- Commercial Support – Novartis