improve risk stratification and guide targeted, personalised interventions and enrich trial recruitment. Methods: This study was conducted at a metropolitan tertiary centre in Brisbane, Australia. All patients known to the Kidney Health service with a biopsy proven IgA nephropathy from January 2010 -August 2025 were included for analysis. Additional cases were identified by screening hospital admissions for relevant ICD-10 codes (e. g. N02. 8: recurrent/persistent haematuria/IgA nephropathy; D69. 0: Henoch-Schnlein purpura), followed by review of kidney biopsy. Results: A total of 153 patients met inclusion criteria; 100 (65%) were male. At diagnosis, the median age was 43 years 3), median eGFR was 52 mL/min/1. 73m 2 (IQR 27. 5-87), and median proteinuria was 1. 95 g/24 h (IQR 0. 77-3. 73). The mean follow-up duration was 60. 7 months (median 47. 4, IQR 23. 0-89. 1). Among 88 patients with 3 years of follow-up, the overall mean change eGFR slope was -2. 12 mL/min/1. 73m 2 /year. Patients with 1 g/day proteinuria (n = 55) had a mean slope of -2. 62 mL/min/1. 73m 2 /year (95% CI -4. 18 to -1. 07) ;There was no statistically significant difference between these groups (Welch's t-test: p = 0. 691). Within the cohort with >1 g/day proteinuria, 27 patients treated with immunosuppression had available 3-year eGFR data. Their mean baseline eGFR was 61. 7 mL/min/1. 73m 2 (95% CI 51. 6-71. 9), and their mean slope was -3. 02 mL/min/1. 73m 2 /year (95% CI -4. 71 to -1. 34). In comparison, 28 patients who did not receive immunosuppression had a mean baseline eGFR of 60. 0 mL/min/1. 73m 2 (95% CI 49. 3-70. 3) and a slope of -2. 24 mL/min/1. 73m 2 /year (95% CI -4. 93 to 0. 46). The difference between treated and untreated groups was not statistically significant (Welch's t-test: p = 0. 62). Overall, 43 of 153 patients (28%) experienced >50% eGFR decline during follow-up, with a median time to event of 31. 3 months; 24 of 153 patients (16%) had documented clinical features of IgA vasculitis, 6 (25%) of whom experienced >50% eGFR decline during follow-up, with a mean time to event of 37. 9 months. Male patients were more likely to experience event (35% vs 15%; RR 2. 32, 95% CI 1. 16-4. 64;p=0. 009). Conclusion: IgA nephropathy remains an aggressive disease with considerable impact on health of people living with the disease in Australia. Despite a significant proportion of patients experiencing decline in kidney function, baseline proteinuria or eGFR does not reliably distinguish those with rapid progression. These results highlight the limitations proteinuria as a predictor of clinical outcome in real-world practice and underscore the need for improved risk stratification strategies to identify high-risk patients and optimise early intervention. I have no potential conflict of interest to disclose. I did not use generative AI and AI-assisted technologies in the writing process.
Bao et al. (Wed,) studied this question.