Analysis of Timing of Referral and Kidney Biopsy for IgAN

The time to referral and kidney biopsy for IgA nephropathy (IgAN) is perceived as lagging, so Philipp Csomor, PhD, and colleagues studied real-world management of IgAN patients from referral to biopsy in five European countries using a physician questionnaire and patient chart review. They shared results during ASN Kidney Week 2024 in a poster presentation titled Analysis of Time to Referral and Kidney Biopsy in IgA Nephropathy in Five European Countries.

Two hundred seventy-two physicians across France, Germany, Italy, Spain, and the United Kingdom completed a  questionnaire on IgAN management and a patient chart audit. All respondents had ≥50 patients with CKD stages 1-4, including ≥4 nondialysis IgAN patients. Patient chart inclusion criteria included age ≥13 years, nondialysis IgAN, and eGFR ≥15 mL/min/1.73 m².

Data of 514 IgAN patients were included. Of these, 71% were referred to their current physician by a primary care physician, 6% were referred by another nephrologist, and 24% were referred for specialized care. Referrals for 94% of these patients were prompted by urine or blood laboratory results.

Although 62% of nephrologists view CKD stage 1-2 as the optimal time to refer patients to specialized care, physicians indicated that 28% of patients were referred late or extremely late. A greater percentage of patients in the UK, France, and Germany (≥60%) were referred to a nephrologist before diagnosis than those in Spain and Italy (≤55%).

Similarly, 72% of nephrologists indicate that all suspected cases of glomerular disease should be subject to a biopsy, yet 9% of patients are presumed to have IgAN without a confirmatory biopsy. This is despite few nephrologists reporting challenges with ordering or having a biopsy performed.

The average time from referral to biopsy was 4.1 months. When biopsies were performed six months or more after referral, reasons for the delay included the physician’s opinion that the patient was not in good enough health for the procedure and that a biopsy did not appear to be clinically relevant at the time.

In summary, many physicians indicated that patients with IgAN are referred to them late or extremely late, and not all potential cases of IgAN receive a timely biopsy to confirm a diagnosis. These findings demonstrate a need for timelier referrals and confirmatory biopsies.

Source: Csomor P, Weiss M, Snyder J, Santos L. Analysis of time to referral and kidney biopsy in IgA nephropathy in five European countries. FR-PO877. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2024; October 25, 2024; San Diego, California. Commercial support for the study was provided by CSL Vifor.