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IgAN Immunological Remission Concept — ESENeph MCQ

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HardGlomerulonephritisIgAN Immunological Remission ConceptESENeph

A 35-year-old man with IgA nephropathy has proteinuria of 1.8 g/day despite maximal supportive care. His nephrologist discusses the KDIGO 2025 concept of immunological remission versus clinical remission. What is immunological remission in IgA nephropathy?

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Correct answer: B — Normalisation of galactose-deficient IgA1 (Gd-IgA1) levels and pathogenic IgA immune complexes – representing suppression of the disease-driving immune process

KDIGO 2025 IgAN guideline introduces the concept that IgAN has distinct immunological and clinical phases. Immunological remission refers to suppression of the pathogenic IgA immune complex formation (measured by galactose-deficient IgA1 levels, anti-Gd-IgA1 antibodies). Disease-modifying therapies (Nefecon, systemic immunosuppression, complement inhibitors) target immunological remission. Clinical remission (proteinuria reduction, stable eGFR) may lag behind immunological changes. Biomarkers like Gd-IgA1 are being developed to monitor immunological response independently of clinical endpoints.

Reference: KDIGO 2025 – IgAN Guideline