Identification of early predictors of clinical remission in primary membranous nephropathy: a analysis of the STARMEN trial.

Background: Patients with primary membranous nephropathy may progress to advanced chronic kidney disease despite immunosuppressive therapy (IST). Prediction of treatment response based on early and combined assessment of several standard clinical markers could improve risk stratification for progression, allowing timely individualization of treatment, which can optimize clinical outcomes and safety.

Methods: In this exploratory analysis of the STARMEN trial, we evaluated if combined baseline data, and IST-induced early changes in standard clinical markers predicted clinical remission at 2 years.

AI-Driven Nephrology: The Role of Large Language Models in Kidney Care.

Background Artificial intelligence (AI) increasingly impacts medicine and medical specialties, including nephrology. Technologies such as large language models (LLMs), decision-support AI, and machine learning-powered predictive analytics enhance clinical care. These AI-driven tools show great potential in areas such as predicting the risk of chronic kidney disease, managing dialysis, supporting kidney transplantation, and treating CKD and diabetes-related kidney issues.

Clinical and Histologic Predictors of Kidney Outcomes in C3 Glomerulopathy and Idiopathic Membranoproliferative GN.

Key Points: Lower eGFR, paraprotein presence, and interstitial fibrosis were associated with a higher risk of kidney outcome. Native disease (versus recurrence post-transplantation), White ethnicity, and lower C4 levels were associated with a lower risk of kidney outcome. A 50% reduction in proteinuria from baseline to a value <1 g/d was associated with a lower risk of kidney outcome.

Complement activation in secondary thrombotic microangiopathies.

Secondary thrombotic microangiopathies (TMA) represent a heterogeneous group of diseases associated with a high risk of kidney failure and death despite available therapeutic strategies. Strong evidence implicates complement dysregulation in the pathogenesis of secondary TMA, and emerging data increasingly suggest that pharmacological blockade of the complement improves the outcomes in patients with secondary TMA. Certain forms of secondary TMA, including postpartum TMA, TMA with coexisting hypertensive emergency and de novo TMA after kidney transplantation exhibit a high prevalence of pathogenic variants in complement genes, similar to those observed in primary atypical hemolytic uremic syndrome.

Malignancies and glomerulonephritis: when to suspect and when to screen?

Glomerular diseases may occur secondary to malignancies. Age-specific cancer screening is recommended for patients with glomerular diseases and may be extended based on the specific risk associated with the detected histopathologic pattern. Membranous nephropathy is the prototype of cancer-associated glomerulonephritis, with 10% of cases presenting with malignancy within a year from diagnosis.

Comparative Analysis of Proteinuria and Longitudinal Outcomes in Immune Complex Membranoproliferative Glomerulonephritis and C3 Glomerulopathy.

Introduction: C3 glomerulopathy (C3G) and primary immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) are rare diseases that share a similar pathogenesis; however, the prognostic significance of proteinuria reduction remains poorly characterized. This study compared the outcomes in C3G and IC-MPGN and assessed the impact of changes in proteinuria on kidney prognosis.

Methods: This retrospective, longitudinal, multicenter study used joint linear mixed-effects models to assess proteinuria trajectories, and Cox regression to evaluate their association with kidney failure.

Clinical Implications of Slope of GFR in Clinical Trials of CKD Progression.

Key Points: Acute effects impact the clinical endpoint independently of treatment effects on the chronic slope. Our findings support the 3-year total slope as the primary slope-based outcome in randomized trials.

Background: Slope of the GFR is considered a validated surrogate endpoint for CKD trials.

Predicting Remission in Antiphospholipase A2 Receptor Antibody-Associated Membranous Nephropathy: A Secondary Analysis of the GEMRITUX, MENTOR, and STARMEN Trials.

Key Points: In phospholipase A2 receptor-membranous nephropathy, clinical variables and antibody levels over 3 or 6 months of treatment were predictors of remission at 1 year. Prediction models at 3 and 6 months had similar performance predicting remission, with the 3-month model allowing for earlier assessment of response. The 3-month and 6-month prediction models could be applied in those treated with supportive therapy, rituximab, calcineurin inhibitors, or cyclophosphamide.

A predicting tool for kidney function recovery after drug-induced acute interstitial nephritis.

Background: Drug-induced acute interstitial nephritis (DI-AIN) represents a common cause of acute kidney injury. Early withdrawal of the culprit drug and corticosteroid therapy remains the mainstay of treatment. This study aimed to develop and validate a predictive nomogram to assess the probability of recovery of kidney function at 6 months after treatment.

Disease-modifying anti-nephropathic drugs (DMANDs)-a definition proposed by the Immunonephrology Working Group (IWG) of the European Renal Association (ERA).

A definition of 'disease modification' for kidney disease is long overdue. Here, we propose three key criteria for disease modification in immune-mediated glomerulonephritis and podocytopathies: minimizing disease activity, preventing loss of kidney structure and function, and reducing treatment-related toxicity. To be considered a disease-modifying anti-nephropathic drug (DMAND), a drug must fulfil all three criteria, hence the DMAND status of a drug may not be clear at the time of regulatory approval.

Tailored management strategies for IgA nephropathy based on clinical presentations.

The treatment landscape for immunoglobulin A nephropathy is rapidly evolving with the introduction of novel therapies targeting diverse disease pathways. Some have already been approved in different countries, while others are under investigation in randomized controlled trials (RCTs) with encouraging results. However, almost all performed RCTs have included only patients with refractory non-nephrotic proteinuria and preserved renal function.

Updated diagnostic and therapeutic management for membranous nephropathy.

Purpose Of Review: Pioneering contributions in membranous nephropathy over the last decade have greatly enhanced our comprehension of its pathogenesis, diagnosis, and treatments, igniting renewed interest in this entity. This review provides an updated perspective on the diagnosis and therapeutic management of membranous nephropathy.

Recent Findings: The identification of antiphospholipase A2 receptor (PLA2R) antibodies in 50-80% of membranous nephropathy patients was a key breakthrough.

Sex dimorphism in kidney health and disease: mechanistic insights and clinical implication.

Sex is a key variable in the regulation of human physiology and pathology. Many diseases disproportionately affect one sex: autoimmune diseases, such as systemic lupus erythematosus, are more common in women but more severe in men, whereas the incidence of other disorders such as gouty arthritis and malignant cancers is higher in men. Besides the pathophysiology, sex may also influence the efficacy of therapeutics; participants in clinical trials are still predominately men, and the side effects of drugs are more common in women than in men.

Antimalarials in Lupus Nephritis: How Strong Is the Evidence?

SLE is a chronic multisystem autoimmune disease that affects the kidneys in approximately 50% of patients, with the prevalence rising to as high as 70% in certain populations, such as African American and Asian people. Antimalarials-and particularly hydroxychloroquine (HCQ)-are currently considered a mainstay of therapy, together with immunosuppressants. Over the past decades, several studies have extensively investigated the mechanisms of action of antimalarial agents and their potential beneficial properties in patients with SLE in general.

Ten tips on immunosuppression in primary membranous nephropathy.

Membranous nephropathy (MN) management poses challenges, particularly in selecting appropriate immunosuppressive treatments (IST) and monitoring disease progression and complications. This article highlights 10 key tips for the management of primary MN based on current evidence and clinical experience. First, we advise against prescribing IST to patients without nephrotic syndrome (NS), emphasizing the need for close monitoring of disease progression.

Developing Therapies for C3 Glomerulopathy: Report of the Kidney Health Initiative C3 Glomerulopathy Trial Endpoints Work Group.

Randomized clinical trials are underway to evaluate the efficacy of novel agents targeting the alternative complement pathway in patients with C3 glomerulopathy (C3G), a rare glomerular disease. The Kidney Health Initiative convened a panel of experts in C3G to ( 1 ) assess the data supporting the use of the prespecified trial end points as measures of clinical benefit and ( 2 ) opine on efficacy findings they would consider compelling as treatment(s) of C3G in native kidneys. Two subpanels of the C3G Trial Endpoints Work Group reviewed the available evidence and uncertainties for the association between the three prespecified end points-( 1 ) proteinuria, ( 2 ) eGFR, and ( 3 ) histopathology-and anticipated outcomes.