The expanding role of biomarkers in the management of IgA nephropathy.

IgA nephropathy is the most prevalent glomerular disease worldwide. To date, a percutaneous kidney biopsy is needed for diagnosis and assessment of disease activity and prognosis. Histology and generic markers of kidney dysfunction, such as proteinuria, hematuria, and estimated glomerular filtration rate, are commonly used to assess kidney damage. Noninvasive biomarkers that can be used to provide diagnostic and prognostic information, enable risk stratification, guide treatment selection, and help monitor treatment response are greatly needed. On the basis of limited data, several promising novel biomarkers specifically related to IgA nephropathy pathophysiology have been proposed and need to be validated and standardized for use in routine clinical care. Once these biomarkers become available, the hope is that they will lead to early diagnosis of IgA nephropathy and provide more accurate prognosis of disease for individual patients. Given the complexity of the pathogenesis of IgA nephropathy, it seems likely that multiple biomarkers will need to be used to optimize patient care.