PROTECTing the kidneys in IgA nephropathy

Treatment of IgA nephropathy has traditionally focused on immunosuppression to address the pathogenesis of the disease and kidney-protective strategies, such as modulation of the renin–angiotensin system to prevent disease progression; 40–50% of patients nonetheless develop kidney failure within 10–15 years of diagnosis.1 The relatively long duration for progression to kidney failure has been a barrier for executing trials of novel therapies for IgA nephropathy. Identification of earlier surrogate markers of beneficial treatment effect—proteinuria reduction and rate of kidney function decline—has improved trial feasibility and contributed to unprecedented industry interest in drug development in IgA nephropathy.