The use of albuminuria or proteinuria for risk prediction in IgAN.

This article focuses on the prognostic significance of albuminuria and proteinuria levels in Immunoglobulin A nephropathy (IgAN), a leading cause of chronic kidney disease and kidney failure worldwide. Recent large-scale studies, including one from the Swedish Renal Registry, demonstrate that even low levels of urinary albumin:creatinine ratio (UACR) and proteinuria, previously considered low risk, are associated with substantial risk of adverse kidney outcomes in IgAN patients. These findings challenge the traditional threshold of 1 g/day proteinuria used in clinical trials and treatment guidelines, suggesting a need to reconsider risk stratification and earlier intervention. The article also highlights ongoing efforts to refine biomarkers and risk prediction tools to better guide therapy choices amid emerging novel treatments targeting various pathogenic pathways in IgAN.