Diagnosis and monitoring of IgA nephropathy: the role of biomarkers as an alternative to renal biopsy

•IgAN is the most prevalent form of chronic glomerulonephritis in the world.•Renal biopsy remains the golden standard for diagnosing and monitoring IgAN.•There is a call for noninvasive biomarkers for detecting subclinical IgAN.•Proteomics and microRNA approaches have identified some new potential biomarkers.

IgA nephropathy (IgAN) is the most prevalent form of chronic glomerulonephritis in the world. The underlying pathogenesis of this autoimmune disease comprises the formation of immune complexes, including glycan-specific IgA1 or IgG antibodies and an aberrant glycosylation of IgA1. Until now, anatomopathological analysis of renal biopsies is essential for the diagnosis of IgAN and different histological classification systems have been proposed, e.g. the Oxford classification. However, a percutaneous renal biopsy is frequently not performed for several reasons and the Oxford classification system has some limitations. Since the poor prognosis of IgAN patients is partly the result of a delayed diagnosis, there is an urgent need for reliable noninvasive biomarkers that might be applicable in routine clinical practice. This article reviews the advances on the understanding of the underlying pathophysiological mechanisms of IgAN and discusses in depth the recent development of new biomarkers, including the use of proteomics and microRNAs.