Stopping an Autoimmune Attack

IgA nephropathy, a frequent cause of kidney failure, is underdiagnosed. New treatments mean it's more important now to find those who will benefit

- By Charles Schmidt

THE MAN IN HIS 50s ARRIVED at Ellie Kelepouris's office carrying a sheaf of medical records. They contained years' worth of laboratory test results that showed microscopic traces of blood in his urine. Kelepouris, a nephrologist at the University of Pennsylvania's Perelman School of Medicine, wasn't the first kidney specialist he had consulted about the problem. "I don't want to have blood in my urine," the man said. "I don't know what's going on." Kelepouris suspected the cause, but it took a kidney biopsy, done in 2024, to confirm it. Her patient had IgA nephropathy (IgAN), an autoimmune disease that is an important cause of kidney failure.

IgAN is far from the most common cause of kidney disease, but up to 40 percent of people who have it will eventually require dialysis or a kidney transplant. Kelepouris's patient was diagnosed while he was still in the early stages of the illness, but that's uncommon. IgAN can develop asymptomatically for years, and by the time it's detected, most patients are already at advanced stages. Today there are emerging precision therapies that can preserve kidney function and potentially stop IgAN in its tracks. But early diagnosis is crucial. The sooner treatment gets underway, the better the odds that “we can push off the need for dialysis, hopefully permanently,” says Brad Rovin, a nephrologist at the Ohio State University Wexner Medical Center.