Backgorund: IgA nephropathy (IgAN) is the most common glomerulonephritis globally, characterized by haematuria, proteinuria, and reduced kidney function. Pathologically, it involves mesangial IgA deposits of IgA immunoglobulin and mesangio-proliferative glomerulonephritis. Its pathophysiology includes abnormally-glycosylated IgA1 antibodies and formation of IgG/IgA1 complexes that deposit in glomeruli, activating complement and pro-inflammatory pathways. Many patients progress to renal failure, requiring dialysis or transplant. Current therapies, including Renin Angiotensin Aldosterone System (RAAS) antagonists [ACE inhibitors (ACEi), Angiotensin Receptor Blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs)], corticosteroids, and SGLT2 inhibitors, slow but do not fully prevent progression. Emerging targeted therapies show promise in clinical trials, emphasizing the need for strategies to identify IgAN patients progressing toward renal failure despite optimal treatment.
Aims and Objectives: The project aim is to analyse longitudinal trends in urine protein and estimated glomerular filtration rate (eGFR) among patients attending the Galway University Hospitals (GUH) Nephrology Department for management of biopsy-proven IgA nephropathy.
Objective 1: Update a previously-performed GUH clinical practice audit of biopsy-proven IgA nephropathy to identify all new cases diagnosed between January 2011 and December 2024.
Objective 2: Extract serial measurements of urine protein creatinine ratio (uPCR), urine albumin ratio (uACR) and eGFR from the electronic health records of all patients with biopsy-proven IgAN who have had outpatient follow-up at GUH for ≥1 year.
Objective 3: Calculate slopes of change for uPCR, uACR, and eGFR for all identified cases and compare them between subgroups treated with optimal or suboptimal RAAS antagonist and SGLT2i therapy.
Hypothesis: Patients with biopsy-proven IgAN who receive less effective RAASi and SGLT2i treatment are more likely to show worsening kidney function (higher uPCR/uACR and lower eGFR) compared to those on effective treatment.