DR JACQUIE EVANS1, A/PROF JESSICA RYAN1,2
1Monash Health, Clayton, Australia, 2Monash University, Clayton, Australia
Biography:
A/Prof Jessica Ryan leads the CKD and GN Service at Monash Health, Victoria, Australia.
Aim:
To characterise patients with Ig A Nephropathy (IgAN) attending an Australian nephrology service and assess adherence to guideline directed therapies.
Background:
IgAN is the most prevalent form of primary glomerulonephritis worldwide and a major contributor to ESKD. Local data in the Australian setting is limited.
Methods:
A retrospective analysis was performed on patients with biopsy-proven IgAN between January 2012 and December 2023 at Monash Health. Patients with confounding diagnoses and inadequate follow-up were excluded (36pts). Data was collected on demographics, clinical features, and treatment regimens. Use of RAS blockade, SGLT2 inhibitors, and immunosuppressive use was examined.
Results:
181 patients with a median follow-up of 39.5 months (Q1 21.8, Q3 75.5) were included. 46% were male with a mean age of 32±16 years at diagnosis. 46% were of Asian ethnicity. Mean eGFR at diagnosis was 52 ±17 ml/min. Median proteinuria was 266 mg/mmol (Q1 70, Q3 340) and 84% had haematuria. At diagnosis 38.7% of patients had CKD stage 4 or 5. 26.5% of patients reached ESKD during the follow-up period at a median of 56 months (Q1 3, Q3 40). Proteinuria greater than 300 mg/mmol at diagnosis was significantly associated with faster decline in estimated glomerular filtration rate (p = 0.029). At last clinical review, 65% of patients achieved blood pressure targets, 45% were on maximal doses of RAS inhibitors, and 29% of patients were on SGLT2 inhibitors. Only 10.6% of patients received oral corticosteroids at any time.
Conclusion:
Many patients with IgAN present late in their disease course. There is scope to diagnose earlier, optimize adherence to existing clinical guidelines and improve patient outcomes in this high-risk population.