If you are coming to the NephJC party tonight catch the bus at 7:00 at the corner Avenida De Las Americas & Rusk St at the corner of the conference center nearest Hall A. Near the restaurant, Grotto.

Got #KidneyWk FOMO like @nephroseeker.medsky.social ? We got you covered with daily coverage of the simultaneous publications! www.nephjc.com/news/kidneyw...

Don't forget! Tonight is #NephJC night, and it will be a blast 🪩 👋If you're on #KidneyWk, don't be shy, just say hi ✨For tickets, location, and more specifics, see the link 👇👇 www.nephjc.com/news/2025/10...

watch out - ORIGIN-3 and FINEONE likely simultaneous publications tomorrow morning! #KidneyWk

#NephJC at #KidneyWk 🔥🔥We have all sorts of events 🗓️ Friday, a classic: #NephJC night- #NephJCKidney Awards, @freelyfiltered.bsky.social live recording + lots of fun 🗓️ Saturday, Nov 8th, 6:30 am- will start the day with a nephro run 🏃🏃 For more info 👇👇 www.nephjc.com

This is Akshaya 👩‍⚕️@nephromommy-akshu.bsky.social signing off! Do checkout our department's page - x.com/CMCNephrology Have a wonderful day, and an amazing scientific feast at #kidneyweek! Nandri - Vanakkam 💙✨🙏 #NephJC

Heartfelt gratitude to our mentors 🌟 @kidneyboy.bsky.social,@nephroseeker.medsky.social,@dramiliflores.bsky.social,@brianrifkin.bsky.social and @drpallaviprasad.bsky.social for being so kind, patient, and supportive — thank you for fine-tuning everything to perfection. You’re the best! 💙 #NephJC

Hope you all had an enriching discussion and got some new perspectives. 📈 📊 I would love to thank my team Dr Sai Vani @drsaivani.bsky.social, Natalia @roxnonna23.bsky.social, Bogdan @thekidneywhisperer.bsky.social and Janany @glomerican.bsky.social for all the hard work! Cheers to us ! 🎉🥳

If you want to support #NephJC and get some cool merch, check out 🥤👕🎒 www.nephjc.com/merch...#NephJC

If you want to stay on top of #NephJC happenings, sign up for our once a week newsletter 📰 📢 www.nephjc.com/newsl...#NephJC

Up next! ☀️📚 We're going to #KidneyWeek in Houston! Many late breaking simultaneous papers to be sure (plenty to pick from, we’d love to hear your choices). Hope to see many of you at the #NephJC party 🎈

Don’t forget to support #FOAMed and #NephJC with our annual fundraiser. Every donation helps keep us going (even as unpaid volunteers). 🫶🫶🫶 www.nephjc.com#FOAMed

🤔 What did we miss? 🧐 What else caught your attention and should be discussed? ✅❌ What did KDIGO get right/wrong? ⏰ Do you want more frequent disease-specific guidance? #NephJC

🟢First-ever guidelines fully dedicated to IgAN 🟢Aim to deliver a practical, risk-aligned, & updated treatment guidance. 🟢Advances precision risk stratification by histology, proteinuria trajectories, and validated prediction tools. 🔴Yet, we are already anticipating an update. #NephJC

APRIL/BAFF inhibition: 🎯💊🩺 Trials are under way on this pathway, which promise to get to the root cause of IgAN. However, with great innovation comes…greater confusion. Sequence of treatment, cost, and side effects will need to be considered when increasing immunosuppression. #NephJC

Additional studies of endothelin antagonists, complement inhibition (iptacopan, avacopan, ravulizumab, IONIS-FB-LRx), and APRIL/BAFF inhibition (atacicept, telitacicept, povetacicept, sibeprenlimab) are currently underway. The next IgAN update will have much to discuss! #NephJC

Areas of future research: 💉🩺 Though we have learnt a lot on IgA Nephropathy today, still incomplete knowledge of many grey areas to be answered. What do you want to know more about IgAN in the next update (2 years)? #NephJC

IgAV with RPGN: 🚨 Treatment should follow the KDIGO 2024 recommendations for ANCA-associated vasculitis, consisting of systemic glucocorticoids in combination with cyclophosphamide/rituximab. #NephJC

IgAVN without RPGN: 💊💉🩺 No proven therapies that prevent the formation of pathogenic IgA immune complexes. Glucocorticoids may be used in selected cases after careful evaluation of the risk–benefit profile, preferably at low doses and with appropriate infection prophylaxis. #NephJC

Treatment: 💊🩺 Systemic glucocorticoids are not recommended for preventing renal involvement in patients with IgAV without nephritis. Management follows similar principles to those used in IgAN: BP control, RASi, possible addition of SGLT2i, and lifestyle modification. #NephJC

IgA Vasculitis- Prognosis 📈 Bad prognostic factors uncontrolled HTN and ⬆️proteinuria at presentation and during follow-up. Oxford MEST-C score helps histologic assessment, especially E1(endocapillary hypercellularity) ➡️ Faster disease progression. #NephJC

IgA Vasculitis A kidney biopsy is mandatory in patients with persistent proteinuria ≥0.5 g/day for more than 4 weeks, impaired kidney function, or suspicion of rapidly progressive glomerulonephritis (RPGN). #NephJC

IgA Vasculitis or HSP: 🥵 Formerly known as Henoch–Schönlein purpura (HSP), is a small-vessel vasculitis characterized by IgA deposition, typically affecting the skin, joints, gastrointestinal tract, and kidneys. #NephJC

Follow up of pediatric patients: 👶🩺 Target UPCR <200 mg/gm and SBP in the <90th percentile of age sex and height. At least annual follow-up of BP, GFR and proteinuria should be done. #NephJC

Followup treatment of immunosuppression in children #NephJC

Treatment in children: 👶💉 Management is based on RAS blockade, salt restriction, and blood pressure control. Glucocorticoids are used in those with persistent proteinuria or high-risk features, sometimes combined with cyclophosphamide in severe cases. #NephJC

Kidney biopsy in children (cont): 👶💉 Kidney biopsy specimens of children with IgAN show more inflammation, mesangial and endocapillary proliferation compared to adults. This might be because associated with doing an early biopsy, due to visible hematuria. #NephJC

Indications for kidney biopsy in children: 👶💉 Presents as hematuria, proteinuria and ⬇️ GFR, with normal C3. Biopsy should be performed: 👶At presentation 👶Persistent, recurrent hematuria, Nephrotic proteinuria or ⬇️eGFR 👶Hematuria + 200-500mg/g in 3 measurements 1-2w apart #NephJC

IgAN in children: 👶🩺 Children tend to have more episodes of visible (gross) hematuria. These episodes often coincide with URIs. 🩸 Hence children tend to present early, with preserved GFR and less proteinuria compared to adults. #NephJC

IgAN and lactation: 🤱💊 Sparsentan and nefecon are contraindicated. The only ACEi that is approved for use, if clinically indicated, is enalapril (monitor baby for low BP as trace amounts can be found in breast milk). #NephJC

IgAN & pregnancy (cont’): 🤰🩺 Females with IgAN should be counseled regarding contraception. Discussions about postponing pregnancy & the need for immunosuppression should be done. Counseling about the risk of rapid progression should be done with pts of childbearing age & progressive CKD. #NephJC

IgA nephropathy & pregnancy 🤰🩺 #NephJC IgAN is common in young females. 👶Fetotoxic meds - RASi, sparsentan, Nefecon, SGLT2i, systemic steroids, prior to conception. 👶Alternatives for HTN 👶Steroids in1st trimester has the risk of cleftlip/cleft palate. 👶Nefecon is class C.

Special situation: 🚑 Rapidly progressive IgAN (RPGN) #NephJC ≥50% ⬇️ in eGFR in ≤3 months, after excluding reversible causes. 🚨Kidney emergency - Initiate immunosuppression early, especially combination of cyclophosphamide and steroids. Would you consider rituximab? Plasmapheresis?

Special situations: IgA with AKI 🆘: AKI may occur during episodes of gross hematuria, usually improves after control of hematuria. Sometimes RPGN masquerades as AKI, so act early and have a low threshold for renal biopsy if there is uncertainty. #NephJC

Special situations: IgA with Nephrotic syndrome: presentation is rare but associated with podocytopathy. Treat according to the histological pattern and clinical presentation. With the impending approval of DEARAs for FSGS, should it be first line in these patients? #NephJC

SGLT2 inhibitors: 💊 Beneficial hemodynamic & anti-inflammatory effects on 🫘, independent of glycemic control. DAPA CKD & EMPA kidney trials showed positive effects of SGLT2i in IgAN. Concern about ⬆️ genital mycotic infections especially when used along with steroids. #NephJC

The final recommendation for Sparsentan is Grade 2b for progressive loss of kidney function. Have you started using this medication for patients with IgAN? Do you try RASi first? #NephJC

Sparsentan ADRs: Giddiness,hypotension and fetal toxicity. Females are advised to avoid pregnancy during use. Additionally, FDA rec LFTs at initiation and then q3 months. #NephJC

Sparsentan is a dual endothelin and angiotensin II receptor antagonist (DEARA). The PROTECT trial compared the efficacy of sparsentan vs irbesartan. Sparsentan had significant ⬇️proteinuria 49.8% & slower decline of eGFR (+3.3 cc/minat 2 years). #NephJC

Recommend RASi use regardless of presence of HTN but should be done with caution in those with ⬇️ BP, bilateral renal artery stenosis & ⬆️ K+ (practice point 1.4.4.2). Use of RASi should not preclude the use of therapies targeted against IgA production or glomerular inflammation. #NephJC

Here are some KDIGO recommendations for managing the generic response to IgAN induced nephron loss. Do you routinely do these? Do you agree with a BP goal < 120/70? #NephJC

Based on the low dose TESTING trial, KDIGO recommends Methylprednisolone 0.4 mg/kg/d for 2 months followed by ⬇️ in dose by 4 mg/d monthly for a total duration of 6-9 months (2b). This should be accompanied by prophylaxis against PJP & antiviral prophylaxis for Hepatitis B carriers. #NephJC

Nefecon 💊: In partial remission, should it be continued? After 9 months does it completely stop immune complex production? In relapses should it be reinitiated? The ideal duration/dose still need to be determined #NephJC #NephJC

Nefecon: 💊 The Nefigan Phase 2b (Lancet 2017) & the Nefigard trials (Lancet 2023), suggested oral budesonide specifically targeted against the Peyer’s patches. Targeting the first hit of IgA nephropathy pathogenesis, hoping for precision medicine. #NephJC

The evidence of immunomodulatory effects of steroids and Nefecon comes from the following trials. High dose steroids treatment suffered from complications like infections. Nefecon, however, still showed similar systemic side-effects of other oral steroids. #NephJC

The immune complexes produced from the gut affects the kidneys downstream. The guidelines give the following two 2B recommendations regarding Nefecon and systemic steroid use. What do you use in your patients? Do you think Nefecon is superior, or that it has fewer side effects? #NephJC

Treatment Approach: 💊 Novel therapies for IgAN have shifted the paradigm to a bi-pronged approach. a) Generic responses to HTN/proteinuria b) Fundamental drivers of nephron loss by reducing the formation of aberrant IgA molecules & the maladaptive mechanisms that contribute to CKD. #NephJC

Treatment targets: 🎯 The only activity marker we can measure in IgAN is proteinuria. Target: ⬇️ to <0.5g/d (or ideally <0.3g/d). Even moderate proteinuria - associated with worse outcomes. The goal for GFR decline - Shouldn't be > the age-related decline ~ 1ml/min/yr in adults #NephJC

The importance of regular follow-up is stressed as IgAN may develop over decades. Since patients with IgAN classically present at a young age, a 5-year risk prediction for kidney failure may not be helpful for long-term outcomes in IgAN. #NephJC

Clinical importance of prediction tools: 🔬 The prediction tool was developed with the data from 4000 people in multinational and multiracial cohorts and can be generalized to all. Do you routinely use prediction tools with IgAN patients? #NephJC