Yet delayed referral to nephrology was the most frequently selected barrier to earlier intervention, identified by 20 of the 25 respondents. This suggests that the major constraint occurs before treatment decisions can be made. Although delays in referral can arise for many reasons, the other leading barriers offer insight into where the gap may begin. Under-recognition of proteinuria or haematuria in primary care, and patients first presenting to specialist care after their disease had already progressed, both point to challenges early in the IgAN care pathway—particularly between the identification of initial kidney abnormalities and specialist assessment. Taken together, the findings suggest that the most prominent perceived barriers occur before diagnosis, revealing a critical signal-to-specialist gap centred on recognising early kidney abnormalities and involving nephrology in a timely manner.