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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.
Japanese guidelines for IgA nephropathy (IgAN) recommend several treatments, including tonsillectomy, which is commonly performed in about 15-40% of IgAN cases (PLoS One.2014;9(3)&SciRep.2023(13)). However, treatment approaches differ widely across institutions, and the influence of baseline urinary findings and renal function on therapeutic decisions remains unclear. This study aims to characterize real-world treatment patterns stratified by urine test status and estimated glomerular filtration rate (eGFR).
This retrospective cohort study analyzed the data from the DATuM IDEA (EMR database) of 55 national hospitals across Japan, encompassing approximately 1.2 million patients. Adults (≥18 years) with IgAN who had ≥3 measurements each for both urinary protein and occult blood were included. Patients with prior kidney transplantation, prior tonsillectomy, or an insufficient observation period (less than 6 months) were excluded. An alluvial diagram illustrated the treatment trajectories and clinical outcomes stratified by baseline characteristics. Patients were categorized into four groups based on baseline urinary findings: (1) urinary protein (≥1+) and hematuria (≥1+), (2) urinary protein (≥1+) only, (3) hematuria (≥1+) only, and (4) both urinary findings <1+. Each cohort was further stratified by baseline CKD stage; G1/G2 and G3a+. The alluvial visualization displayed 3 sequential nodes: (1) tonsillectomy with or without steroid pulse therapy, steroid pulse therapy alone, oral steroid therapy alone, or no immunosuppressive therapy, (2) RAS inhibitors (RASi) or SGLT2 inhibitors (SGLT2i), and (3) complete clinical remission or non-clinical remission. Flow widths were proportional to patient counts, enabling simultaneous comparison of treatment distributions and outcome proportions across baseline phenotypes.
Distinct treatment patterns and outcomes varied by baseline urinary findings and CKD stage. Immunosuppressive approaches, especially tonsillectomy with or without steroid therapy, were mainly used in patients with higher proteinuria and better renal function, while those with CKD stage G3a+ predominantly received supportive therapy. Among 127 patients with proteinuria (≥1+) and hematuria (≥1+) with CKD stage G1/G2, 34.6% (44 patients) received tonsillectomy combined with steroid pulse therapy. Despite this intervention, 72.7% (32/44) failed to achieve complete remission. In this baseline group, 52.8% (67 patients) used RASi and/or SGLT2i, and only 14.9% (19 patients) achieved complete remission. For 134 patients with baseline proteinuria (≥1+) and hematuria (≥1+) with CKD stage G3a+, 20.9% (28 patients) underwent tonsillectomy combined with steroid pulse therapy, with 64.3% (18/28) not achieving complete remission. Furthermore, in this baseline group, 78.4% (105 patients) used RASi and/or SGLT2i, achieving 18.1% (19 patients) remission.
The study presented that many patients did not achieve complete remission regardless of treatment choice or intensity. These findings underscore the urgent need for more effective, targeted therapies to improve outcomes for IgAN patients.
