Abstract: TH-PO0463
Proteinuria and Kidney Outcomes in IgA Nephritis and IgA Nephritis with Vasculitis in Children and Adults in North America
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - IgAN
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Khalid, Myda, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
- Lancki, Nicola, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Helmuth, Margaret, University of Michigan, Ann Arbor, Michigan, United States
- Smith, Abby, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Bomback, Andrew S., Columbia University, New York, New York, United States
- Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Saha, Manish K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Fernandez, Loreto, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Blazek, Lauren N., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Konda, Raghunandan, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Naqvi, Kiran Z., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Wilson, Sherry Louise, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
- Rizk, Dana V., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
Background
Proteinuria reduction is a reasonably likely surrogate endpoint for clinical trials in IgA nephropathy (IgAN). We sought to identify predictors of disease progression in children and adults with IgAN/IgA vasculitis with nephritis (IgAVN) in North America.
Methods
Data from the Cure Glomerulonephropathy Network, Kidney Research Network, University of North Carolina, University of Alabama at Birmingham, Indiana University and Columbia University were harmonized to assess rates of eGFR decline, kidney failure (KF) and death in adults and children with IgAN/IgAVN. Among participants with≥1 UPCR ≥0.3 g/g with eGFR > 30 mL/min/1.73m2 within 30 days, 24mn time-averaged proteinuria (TAP) was calculated as area under the curve of serial UPCRs divided by follow-up time. Associations with kidney failure (transplant, dialysis, sustained eGFR <15, or death), and eGFR decline (≥40% for adults, ≥30% for children) were tested using log-rank tests and Cox proportional hazards models.
Results
Of 941 patients, 64% were adults; 59% were male and 72% were White. IgAVN was more common in children (45% vs 10% adults). UPCR (g/g) distribution was similar across age groups; 0.3-<0.5: 13%, 0.5-<1:21%, 1-<3: 40%, ≥3:26%. Median (IQR) eGFR was 64 ml/min/1.73m2 (47,91) in adults and 97 ml/min/1.73m2 (76,117) in children. Over a median follow-up of 5.5 years, KF occurred in 17% of adults and 5% of children; death in 3% and 2%, respectively. eGFR decline thresholds were reached in 35% of adults and 16% of pediatric patients. In adults, 24mn TAP 1-<3g/g and ≥3 g/g was associated with higher hazard of KF compared to 24mn TAP<0.5 g/g (HR [95% CI]=2.9 [1.3-6.4] and 7.4 [3.2-17.0], respectively. In children 24mn TAP≥3 g/g was associated with higher hazard of KF compared to 24mn TAP<0.5 g/g (HR [95% CI]=11.9 [1.5-96.5]. Relationships with eGFR decline and proteinuria showed similar patterns.
Conclusion
In this North American cohort with IgAN/IgAVN, higher proteinuria was associated with faster eGFR decline and KF. Despite overall favorable outcomes in children, clinically meaningful progression occurred in both age groups.
Funding
- NIDDK Support