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nosis and treatment. 2,3 The natural history of IgAN can range from clinically silent urinary abnormalities and preserved renal function over many decades to ESRD. Progression to ESRD occurs in 10%–50% of patients, usually developing slowly over 20 years. 4,5 Ten-year renal survival rates (62%–98%) are also highly variable. 6,7 In regions where renal biopsies are routinely performed for isolated urinary abnormalities (microscopic hematuria, minimal proteinuria ,0.5 g/d), the incidence of IgAN is higher, and the estimates of renal survival are affected by lead-time bias. A more fully informed understanding of the natural history of IgAN across its entire clinical and histologic spectrum could assist clinicians in assessing prognosis and implementing treatment. Muchhasbeenlearnedoverthelast20–30yearsregarding risk stratification of IgAN. 3 Clinical parameters that correlate with increased risk of progression of disease include proteinuria .1 g/d, hypertension, and reduced GFR. The impact of these variables on prognosis is strengthened when they are followed over time. In contrast to other glomerular diseases, proteinuria in IgAN at an excretion rate of even 0.5–1.0 g/d is associated with risk of ESRD. 3

How Benign Is IgA Nephropathy with Minimal Proteinuria?