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Using longitudinal data from the Japan IgA Nephropathy Prospective Cohort Study (J-IGACS), we sought to identify the post-biopsy time point at which proteinuria most reliably predicts kidney outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Proteinuria was assessed at baseline and at 6, 12, 18, and 24\u00a0months after biopsy. The primary outcome was defined as a\u2009\u2265\u200950% increase in serum creatinine or initiation of kidney replacement therapy in adults (\u2265\u200920\u00a0years) and as a\u2009\u2265\u200925% decline in eGFR or initiation of kidney replacement therapy in patients aged\u2009&lt;\u200920\u00a0years. Model performance was compared using the corrected Akaike Information Criterion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 588 patients (median age 38\u00a0years; mean eGFR 76.5\u00a0mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ; median proteinuria 0.64\u00a0g\/day), 43 (7.3%) reached the primary outcome during a median 78-month follow-up. Proteinuria at all time points was independently associated with kidney outcomes, with the 18-month measurement providing the best model fit. A threshold of 0.44\u00a0g\/day (or g\/gCr) yielded 79% sensitivity and 81% specificity, and patients with proteinuria\u2009\u2265\u20090.44\u00a0g\/day at 18\u00a0months had significantly worse outcomes. Cox regression confirmed a robust association for 18-month proteinuria, irrespective of treatment type or timing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Proteinuria measured 18\u00a0months post-biopsy showed the strongest association with long-term kidney outcomes in IgAN, supporting its use as a universal treatment target across heterogeneous post-biopsy clinical courses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10157-025-02808-3","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T14:15:30Z","timestamp":1770214530000},"page":"498-506","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-biopsy proteinuria as a universal prognostic marker across diverse clinical courses in IgA 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