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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
In IgA nephropathy (IgAN), proteinuria <0.5 g/day is generally associated with a favorable renal prognosis, and major guidelines (KDIGO and Japanese) usually do not recommend intensive immunosuppression in this setting. Nevertheless, some patients still experience disease progression. In our prior multicenter retrospective secondary analysis, baseline eGFR <60 mL/min/1.73 m² independently predicted adverse renal outcomes even when proteinuria was<0.5g/day.
We aimed to clarify renal outcomes among patients with proteinuria <0.5 g/day and the potential need for intensive treatment defined as immunosuppressive therapy (including corticosteroids) and tonsillectomy, using secondary analysis of a multicenter prospective cohort study of patients with IgAN.
Among 1,130 patients enrolled in the Japan IgAN Prospective Cohort Study （J-IGACS） (2005–2015), 470 with baseline urinary protein excretion (UPE) <0.5 g/day and follow-up eGFR data were analyzed. Intensive treatment was defined as corticosteroid or immunosuppressant use and/or tonsillectomy within one year of enrollment.
The primary outcome was a composite kidney endpoint (≥30% eGFR decline or kidney replacement therapy). The secondary outcome was annual eGFR slope estimated by a linear mixed-effects model including a treatment × time interaction.
Propensity scores were calculated using age, sex, blood pressure, hypertension, RAAS inhibitor use, Oxford MEST-C scores, baseline eGFR, log-transformed UPE, and microscopic hematuria. Based on the propensity score, inverse probability of treatment weighting (IPTW) was applied to estimate weighted hazard ratios using a Cox proportional hazards model with a weighted Kaplan–Meier curve and to estimate the eGFR slope using the mixed-effects model. Subgroup analyses assessed treatment interactions, particularly by UPE (<0.3 or ≥0.3 g/day).
Intensive-treatment significantly reduced the risk of the composite kidney endpoint compared with nonintensive treatment (HR 0.459, 95% CI 0.239–0.883, P=0.020). There was significant effect modification by urinary protein excretion (UPE, g/day; P for interaction=0.041): the treatment effect was not significant when UPE <0.3 g/day (HR 0.70, P=0.46) but was significant when UPE ≥0.3 g/day (HR 0.22, P=0.02). Using a linear mixed-effects model with a treatment×time interaction, the intensive treatment group showed a significantly slower decline in eGFR than the nonintensive treatment group. The 2-year between-group difference was 2.40 mL/min/1.73 m²/year (95% CI 1.11–3.69), and the interaction was significant (P<0.001). In subgroup analyses of the slope, the interaction term was not significant for UPE <0.3 g/day (β=1.70, P=0.068) but was significant for UPE ≥0.3 g/day (β=3.69, P=0.0002), indicating a clearer attenuation of eGFR decline with intensive treatment.
In patients with IgAN, analyses of the primary and secondary outcomes suggest that intensive treatment is associated with a significantly lower risk of kidney events and a slower decline in eGFR. Subgroup analyses indicated heterogeneity of treatment effect by urinary protein excretion, with a more pronounced renal-protective effect when UPE ≥0.3g/day (e.g., corresponding to 0.3–0.5 g/day). These findings support considering intensive therapy in IgAN patients with mild proteinuria whose UPE levels are relatively higher.
