IgA nephropathy, also known as Berger’s disease, is one of the most common forms of glomerulonephritis. While some individuals experience a slow, stable disease course, others may face progressive kidney damage leading to chronic kidney disease or even kidney failure. Understanding the key risk factors for progression of IgA nephropathy is critical for patients, caregivers, and clinicians aiming to manage the condition proactively.
Proteinuria: A Leading Indicator of Disease Severity
Persistent proteinuria—especially levels greater than 1 gram per day—is widely recognized as one of the strongest predictors of disease progression in IgA nephropathy. Studies show that even in patients with preserved kidney function, elevated urinary protein can signal future renal decline.
Clinically, nephrologists monitor urinary albumin levels to assess progression risk, often adjusting treatment based on these results.
Hypertension and Poor Blood Pressure Control
High blood pressure is both a cause and consequence of kidney damage. In IgA nephropathy, uncontrolled hypertension contributes to glomerular injury and accelerates the loss of kidney function. Maintaining target blood pressure below 130/80 mmHg is a cornerstone of long-term management.
Patients with both hypertension and proteinuria are considered high-risk for disease progression, prompting earlier consideration of immunosuppressive or RAAS-inhibiting therapies.
Reduced Kidney Function at Diagnosis
Initial kidney function, measured via eGFR (estimated glomerular filtration rate), is another important prognostic factor. Patients diagnosed with already impaired eGFR are more likely to experience progression compared to those diagnosed in earlier stages.
Monitoring eGFR over time helps predict the rate of decline and informs decisions regarding nephrology referral and potential dialysis planning.
Histological Findings: MEST-C Score in Risk Assessment
Kidney biopsy results provide valuable insight into disease severity. The Oxford MEST-C scoring system evaluates:
Mesangial hypercellularity (M)
Endocapillary hypercellularity (E)
Segmental glomerulosclerosis (S)
Tubular atrophy/interstitial fibrosis(T)
Crescents (C)
A higher T or C score correlates with increased risk for rapid progression of IgA nephropathy, even in patients with mild clinical symptoms.
Male Sex and Younger Age at Onset
While the disease affects both sexes, several cohort studies have found that male patients tend to progress more rapidly than females. In contrast, those diagnosed at a younger age often experience a slower initial decline but may require long-term monitoring due to cumulative kidney damage over decades.
Genetic and Ethnic Factors
Certain populations, particularly individuals of Asian or Caucasian descent, have higher incidence rates of IgA nephropathy. Genetic predispositions, including specific HLA types and complement pathway mutations, may contribute to disease progression risk in susceptible individuals.
Emerging research is exploring how genetics may eventually guide personalized therapy for IgA nephropathy patients.
Delayed Diagnosis or Lack of Treatment
Asymptomatic hematuria is often the only early sign of IgA nephropathy. Unfortunately, many patients go undiagnosed until proteinuria or renal function decline appears. Lack of early intervention—whether through RAAS blockade, blood pressure control, or lifestyle changes—can lead to missed opportunities for disease stabilization.
Patients seeking a second opinion or referral to a nephrology specialist often search terms like:
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Conclusion
The progression of IgA nephropathy is influenced by multiple interrelated factors, including proteinuria, blood pressure control, baseline kidney function, biopsy findings, and genetics. Understanding these risk factors allows both patients and providers to tailor a management strategy aimed at slowing decline and preserving kidney function.
For those recently diagnosed or undergoing follow-up, discussing these variables with a nephrologist is essential. Early detection and individualized care remain the most effective tools for improving long-term outcomes.