Jonathan Barratt, PhD, FRCP: Gerald, you work in a New York City with a highly diverse population. In terms of the patients, you look after, are there any groups of patients that have more aggressive disease or perhaps more commonly have developed nephropathy? I'm putting that into a global perspective.

Gerald B. Appel, MD: That is certainly true that the disease is more common in people of Asian descent, east Asian descent, certainly. And, it comes to attention, at least in the United States in New York City in younger people. Now, even though you can see octogenarians with the disease, most of the people present either in teenage years or up through their 30s. It's younger people, people of Asian descent will have more vigorous disease, and it's less common in people of African-American descent. Which is interesting because there are other diseases which we know are much more common, glomerular diseases in people of African American descent. But it's just the opposite here.

Jonathan Barratt, PhD, FRCP: And I don’t know how your practice might mirror mine in the UK, but for me, no 2 IgA nephropathy patients are the same. We can have patients that have very similar biopsies with lots of IgA deposited there, but, some patients will do very well and actually will only be troubled with minor urine abnormalities, whereas others will be on dialysis within a matter of years. Is that your experience there in term that heterogeneous natural history of the disease?

Gerald B. Appel, MD: Yes. That is absolutely the case that no 2 people are the same in terms of this. And even though they may present the same, what happens? Can you get rid of the proteinuria and change their prognosis? Other people, you can't do it. That biopsy is very valuable. It's certainly, you can add on and we'll hear about this later, I'm sure, but you can add on to what the prognosis is by looking at the biopsy here. Because again, this is one of the diseases where the scoring system for the biopsy has tremendous value in predicting what happens. And there are also risk stratification tools, which can look at age, use of agents such as blockers of the renal angiotensin system, immunosuppressives using the MEST score in terms of the Oxford classification for the biopsy. You can put this into a model and make a prediction whether this person is going to have a progressive course over a short period of time after the biopsy.

Transcript Edited for Clarity