What Is the Long-Term Kidney Failure Risk With IgAN?

When you are diagnosed with IgA nephropathy (IgAN), one of the most pressing questions is whether it will eventually lead to kidney failure. It is important to know upfront that kidney failure is not inevitable.

While population studies show that a significant portion of people with IgAN may eventually need dialysis or a kidney transplant, your individual risk depends heavily on how your kidneys are functioning right now, the specific damage seen on your biopsy, and how well you respond to treatment. Because treatments and care have improved, historical statistics may not accurately predict your personal future.

Understanding Long-Term Risk Estimates

Researchers track large groups (cohorts) of patients over decades to estimate the risk of developing end-stage kidney disease (ESKD), which is typically defined as kidney failure requiring dialysis or a transplant, or sometimes as a severe drop in kidney function (such as a 50% decline).

Because different studies look at different types of patients and measure different endpoints, it is important not to view these percentages as a single, universal progression curve. Here is a summary of long-term risk estimates from contemporary studies:

*Note: In this 25-year Norwegian study of patients with very mild disease at diagnosis, the actual rate of kidney failure was only 2.8% at a median follow-up of 22 years, highlighting that mild presentations have much better long-term outcomes.

It is vital to remember that these are population averages, not individual predictions ^[5]. Medical studies group patients together, meaning people with aggressive disease and people with mild disease are averaged into one percentage.

Factors That Raise or Lower Your Risk

Doctors look at several key factors to estimate whether your specific case is high-risk or low-risk:

• Baseline eGFR (Estimated Glomerular Filtration Rate): This measures how well your kidneys are filtering waste when you are diagnosed. A lower eGFR at diagnosis is strongly linked to a higher long-term risk of kidney failure ^[6][7].
• Sustained Proteinuria: The amount of protein leaking into your urine over time is one of the most critical predictors of long-term kidney health ^[3]. Because a single test can fluctuate, doctors look at your time-averaged proteinuria (the average across multiple tests). Higher, persistent levels increase the risk of progression ^[8].
• Blood Pressure: Uncontrolled high blood pressure (hypertension) puts extra stress on the kidneys and is independently linked to worse long-term outcomes ^[9][7].
• MEST-C Biopsy Score: Pathologists grade kidney damage using the Oxford MEST-C score. These findings are associated with your prognosis, though they must be interpreted alongside your lab results and do not automatically dictate a specific treatment ^[10][11]:
  • M (Mesangial hypercellularity): Extra cells in the kidney’s filters.
  • E (Endocapillary hypercellularity): Extra cells inside the capillary loops.
  • S (Segmental glomerulosclerosis): Scarring in parts of the filters.
  • T (Tubular atrophy/interstitial fibrosis): Scarring in the kidney’s tubule system.
  • C (Crescents): Active inflammation in the filters.
• Age at Diagnosis: Age is one input in prediction models. While older age combined with other risk factors can influence how the disease progresses, it is evaluated as part of your whole clinical picture ^[7][12].

Favorable Signs to Watch For

Because IgA nephropathy is a chronic condition, your care team will monitor you regularly. Two major signs suggest a favorable long-term outlook:

1. Sustained Reduction in Proteinuria: A significant drop in urine protein after starting treatment is a very positive sign. Current guidelines generally recommend lowering proteinuria to below 0.5 grams per day, and ideally closer to 0.3 grams if safely achievable ^[3]. Sustained lower levels are associated with delayed disease progression ^[13][14].
2. Stable eGFR: A sustained, confirmed stable eGFR is reassuring, though it does not eliminate future risk ^[15][13]. Keep in mind that eGFR can naturally fluctuate due to hydration, illness, or certain medications. A small, early drop in eGFR after starting kidney-protective medicines is often expected and does not necessarily mean your kidneys are failing. Your doctor will look at the long-term trend (the slope) rather than a single isolated number.

Why the “Treatment Era” Matters

When reading about 20- or 25-year risks, it is important to realize those statistics often come from people diagnosed decades ago ^[16]. Today, the standard of care is different ^[17]. We now have better medications to control blood pressure and protect the kidneys. This includes RAAS inhibitors (renin-angiotensin-aldosterone system medicines, such as ACE inhibitors and ARBs) and SGLT2 inhibitors (a class of drugs originally for diabetes that has been shown to reduce the risk of kidney function decline in IgAN) ^[18].

Because of these newer therapies, clinical tools like the International IgAN Prediction Tool—which estimates risk over a specific time horizon, typically 5 years—may not be perfectly calibrated for a patient treated today. Depending on the patient and the therapies used, older risk calculators might over- or underestimate your true danger ^[19][20]. These tools should inform a discussion with your doctor, not replace clinical judgment.

What to Track

Between appointments, it can be helpful to keep a record of:

• Your eGFR and urine protein/albumin trends.
• Your home blood pressure readings.
• Any medications you are taking (never start, stop, or change kidney medicines without consulting your treating clinician).
• Any sudden changes, such as new swelling in your legs, substantially reduced urine output, or breathlessness, which should be reported to your doctor promptly.