1Dr Samee Ullah Khan, 2Dr Khalid Prvez, 3Dr Babar Baig, 4Dr Hafiz Furqan Ahmad, 5Dr
Fazal Muhammad

Predictors of Renal Function Decline in Patients with IgA Nephropathy

Abstract:

IgA nephropathy (IgAN) is the most frequent kind of primary glomerular disease
globally, with a very diverse clinical course, from stable renal function to progressive chronic
kidney disease and kidney failure. Identifying reliable predictors of decrease in renal function is
important for adequate risk categorization and long-term management . To assess the main
clinical, laboratory, histological and longitudinal predictors related with deterioration of renal
function in IgA nephropathy patients.A comparative evaluation based on evidence was carried
out utilizing published clinical studies, systematic reviews, meta-analyses and validated
prognostic models in patients with biopsy-proven IgAN. The primary predictors examined were
proteinuria, estimated glomerular filtration rate (eGFR), serum creatinine, blood pressure, serum
albumin, hemoglobin, complement parameters, and Oxford MEST-C histopathology. We also
evaluated changes in proteinuria and eGFR over time. As there was no source patient-level
dataset, no simulated patient features or statistical estimates were produced. Persistent
proteinuria, decreased baseline renal function, hypertension and unfavorable histopathological
findings were consistently linked to higher risk of renal progression. Recent data has shown that
low-grade and time-averaged proteinuria were related with unfavorable kidney outcomes, underlining the prognostic value of persistent proteinuria. Higher eGFR was related with lower
chance of advancement, and higher serum creatinine and blood pressure were associated with
increased risk. Key Oxford MEST-C lesion connections with renal progression included tubular
atrophy/interstitial fibrosis, segmental glomerulosclerosis and crescentic lesions. Longitudinal
changes in proteinuria and eGFR provided further prognostic information beyond baseline values.
GlobalHealth & Medicine. 2026; 8(3):373-383. Original Article
DOI:10.35772/ghm.2026.01073
Integrated clinico-pathological prediction models further contributed to tailored risk assessment
of progression.The deterioration in renal function in IgA nephropathy is determined by the
interplay of numerous clinical and pathological variables. Persistent proteinuria, lowered eGFR, hypertension and unfavorable MEST-C results are strong predictors of increasing renal failure. Serial examination of proteinuria and eGFR, together with clinical and histological evaluation, allows for complete risk classification and long-term management of patients with IgA
nephropathy.

Key words
IgA nephropathy; renal function decline; proteinuria; estimated glomerular filtration rate;
hypertension; MEST-C; kidney failure; prognostic factors; renal progression.

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