Targets That Change IgAN Trajectory: How Much Proteinuria Reduction Really Matters?

This topic will discuss the central role of proteinuria as the strongest modifiable predictor of disease progression in IgAN. The presentation will review evidence from registry data, retrospective cohorts, and meta‑analyses showing that greater reductions in urine protein excretion are consistently associated with slower decline in kidney function, supporting proteinuria reduction as a validated surrogate marker of long‑term renal outcome. The session will also highlight key recommendations from the KDIGO 2025 Clinical Practice Guideline, including a treat‑to‑target approach aiming for proteinuria below 0.5 g/day, and ideally 0.3 g/day or lower. Emphasis will be placed on dynamic risk assessment, timely treatment escalation, and the importance of early on‑treatment proteinuria response as a practical predictor of long‑term benefit.