Rising creatinine to that extent in the context of IgA nephropathy could represent either acute deterioration because the disease is very active, or else it might reflect a progression of chronic scarring. It is very important to make this distinction because scarring would not respond to immunotherapy whereas active disease could respond to such medication. A renal biopsy would be required to make this distinction and would be important to discuss this matter with your treating nephrologist. Alternatively, another option is a trial of immunotherapy without a biopsy but again, this is something to discuss with your nephrologist.

Dr. Jordan Weinstein