Gaps in Patient Care for IgA Nephropathy

EP: 1.Advancing IgA Nephropathy Care: Emerging Therapies, Unmet Needs, and Economic Considerations

EP: 2.Introduction to IgA Nephropathy

EP: 3.Pathogenesis of IgA Nephropathy: The 4-Hit Cascade, A Proliferation-Inducing Ligand (APRIL), and cytokines

EP: 4.Diagnosing IgA Nephropathy

EP: 5.Signs and Symptoms of IgA Nephropathy

EP: 6.Challenges in Timely Identification of IgA Nephropathy

EP: 7.Clinical Impact of IgA Nephropathy and Quality of Life

EP: 8.Overview of Treatment Landscape for IgA Nephropathy: Standard of Care and KDIGO Guidelines

EP: 9.Current Treatments for IgA Nephropathy and the 4-Hit Cascade

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EP: 10.Gaps in Patient Care for IgA Nephropathy

EP: 11.Emerging Anti-BATH- and Anti-APRIL Therapies

EP: 12.Emerging Therapies: Other Strategies and Important Considerations

Gaps in Patient Care for IgA Nephropathy

Diagnostic Challenges

• Delayed recognition: Asymptomatic nature leads to missed opportunities for early intervention
• Limited access to specialized nephropathology: Inconsistent interpretation of renal biopsies affects accurate diagnosis and risk stratification
• Inconsistent biopsy thresholds: Variability in when clinicians pursue diagnostic biopsies for persistent hematuria or low-grade proteinuria

Risk Stratification and Monitoring

• Inadequate biomarkers: Lack of reliable, noninvasive biomarkers for disease activity and progression risk
• Suboptimal follow-up protocols: Insufficient standardization of monitoring intervals and parameters
• Heterogeneous risk assessment: Inconsistent application of validated prognostic tools (MEST-C scores, clinical risk factors)

Treatment Gaps

• Delayed optimization of supportive care: Suboptimal dosing or premature abandonment of renin-angiotensin-aldosterone system blockade
• Therapeutic inertia: Reluctance to escalate therapy in high-risk patients despite persistent proteinuria
• Limited access to emerging therapies: Geographic and economic disparities in access to novel targeted agents
• Treatment discontinuities: Gaps in care during transitions between pediatric and adult nephrology

Psychosocial Support

• Insufficient patient education: Many patients lack understanding of their disease course and management options
• Inadequate psychological support: Limited resources addressing anxiety, depression, and coping with chronic disease
• Fragmented care coordination: Poor integration between specialty care and primary care providers

Health Care System Factors

• Geographic disparities: Concentration of expertise in academic centers creates access barriers
• Limited clinical trial participation: Underrepresentation of diverse patient populations in therapeutic trials
• Cost barriers: Financial toxicity of long-term medications and monitoring
• Delayed referrals: Primary care providers may not recognize indicators for nephrology evaluation

Research Translation

• Implementation gaps: Slow adoption of evidence-based guidelines into clinical practice
• Personalized medicine challenges: Limited tools for individualizing treatment approaches
• Outcome measurement inconsistencies: Variation in end points used to assess treatment response

Addressing these gaps requires multidisciplinary collaboration, development of practical clinical pathways, improved education for both patients and providers, and continued research into personalized treatment approaches for IgA nephropathy.