• The clinical benefit of systemic glucocorticoids (e.g., prednisone, prednisolone,
methylprednisolone) in IgAN is not established (see Practice Point 2.3.1.3) and
should be given with extreme caution or avoided entirely in situations (see Figure 3).
• These guidelines did not consider targeted release glucocorticoids when they
were developed.
• High risk of progression in IgAN is currently defined as proteinuria >0.75–1 g/d
despite ≥90 days of optimized supportive care.
Overview
Figure 1. Prognosis of CKD by GFR and Albuminuria Categories
Low risk (if no other markers of
kidney disease, no CKD)
Moderately increased risk
High risk
Very high risk
Prognosis of CKD by GFR and
albuminuria categories:
KDIGO 2012
Persistent albuminuria categories
Description and range
A1 A2 A3
Normal
to mildly
increased
Normal
to mildly
increased
Severely
increased
<30 mg/g
<3 mg/mmol
30–300 mg/g
3–30 mg/mmol
>300 mg/g
>30 mg/mmol
GFR
categories
(ml/min/1.73
m
2
)
Description
and
range
G1 Normal or high ≥90
G2 Mildly decreased 60–89
G3a
Mildly to
moderately
decreased
45–59
G3b
Moderately
to severely
decreased
30–44
G4
Severely
decreased
15–29
G5 Kidney failure <15
Selected Highlights
Diagnosis and Prognosis
Practice Point 2.1.1
Considerations for the diagnosis of IgAN
• IgAN can only be diagnosed with a kidney biopsy.
• Determine the MEST-C score (mesangial [M] and endocapillary [E]
hypercellularity, segmental sclerosis [S], interstitial fibrosis/tubular atrophy [T],
and crescents [C]) according to the revised Oxford Classification.
• There are no validated diagnostic serum or urine biomarkers for IgAN.
• Assess all patients with IgAN for secondary causes.
