Abstract: SA-PO0651
Root Cause Analysis of Delayed IgAN Diagnosis: A Literature-Informed Equity and Implementation Science Framework
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - Other
October 24, 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
- Manns, Oni, Glomerular and Genetic Diseases Center, Renal Medicine Associates, Albuquerque, New Mexico, United States
- Vasquez-Rios, George, Glomerular and Genetic Diseases Center, Renal Medicine Associates, Albuquerque, New Mexico, United States
- England-Kennedy, Elizabeth Sara, New Mexico State University College of Health Education and Social Transformation, Las Cruces, New Mexico, United States
- Hebert-DeRouen, Mindy C., New Mexico State University College of Health Education and Social Transformation, Las Cruces, New Mexico, United States
Background
IgA nephropathy (IgAN) may present with hematuria and proteinuria years before substantial eGFR decline. In routine clinical practice, these findings may be overlooked, misattributed, or insufficiently monitored longitudinally, delaying nephrology referral and kidney biopsy. Because definitive diagnosis requires specialty evaluation and histopathologic confirmation, structural barriers may disproportionately affect rural, underserved, and socially vulnerable populations.
Methods
PubMed and Embase were searched for studies evaluating IgAN diagnostic delay, CKD detection, nephrology referral, kidney biopsy access, fragmented care delivery, and kidney health disparities. Identified themes informed development of a systems-level root cause framework using a 5 Whys methodology. Delayed diagnosis was attributed to failures in recognition of urinary abnormalities, longitudinal biomarker surveillance, repeat laboratory evaluation, referral escalation, specialty access, and diagnostic confirmation. Equity domains included rurality, insurance status, social vulnerability, health literacy, trust in healthcare systems, and social drivers of health.
Results
Delayed IgAN diagnosis emerged as a multistep diagnostic cascade failure. Early urinary abnormalities are frequently asymptomatic, intermittent, or attributed to more common conditions. Untrended abnormal labs may delay referral. Referral pathways vary substantially across healthcare settings, and access to nephrology evaluation and kidney biopsy remains inconsistent. Fragmented care delivery further diffuses responsibility for follow-up and diagnostic closure. Structural inequities amplify these failures by limiting access to repeat laboratory evaluation, specialty care, biopsy procedures, and longitudinal follow-up. These delays may contribute to advanced chronic structural injury and reduced opportunity for early therapeutic intervention at the time of diagnosis.
Conclusion
Delayed IgAN diagnosis represents a systems-level diagnostic cascade failure and equity-related challenge extending beyond isolated failures in disease recognition. This framework links missed urinary abnormalities, poor biomarker tracking, fragmented referrals, and structural barriers to delayed diagnosis. Future work should test strategies to improve early detection, referral, and equitable nephrology/biopsy access..