Do you treat persistent microscopic hematuria as a clinically meaningful sign of ongoing disease activity in a patient with IgA nephropathy whose proteinuria is well controlled on current therapy?

The KDIGO 2025 guidelines still regard proteinuria (ideally <300 mg) as the validated early biomarker for IgA nephropathy (IgAN), but persistent hematuria is an independent risk factor for disease progression and should be monitored closely as the marker for glomerular inflammation. Depending upon e...

Proteinuria is easy to measure, so that is why we focus on it as a biomarker. But microscopic hematuria also correlates with outcomes independent of proteinuria (Sevillano et al., PMID 28592423). Unfortunately, it is harder to quantitate hematuria, so we pay less attention to it.

Generally, no.