Assessing prognosis in IgA nephropathy

Floege, Jürgen; Wied, Stephanie; Rauen, Thomas

doi:10.1016/j.kint.2022.04.018

Cited by 10 publications

(10 citation statements)

References 9 publications

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“…This new calculator can assess the relative risk for a 50% loss of estimated glomerular filtration rate (eGFR) and end-stage kidney failure within 80 months (6.7 years) after the biopsy. In an accompanying editorial [3], we show that the calculator performs well in our STOP-IgAN patient cohort, even if extended to 96 months after the original trial initiation. However, we also note that the calculator will likely need continuous refinement given the new emerging therapies discussed below…”

Section: Introductionmentioning

confidence: 77%

“…In addition, it is important to note that the calculator is exclusively based on retrospective data and should not be used to guide particular treatments, as stated in the current KDIGO 2022 guideline on the management of glomerular diseases (www.kdigo.org). At least the limitation related to the time of biopsy has now been taken care of, and the original group of investigators has published an alternative calculator, which can be used at 1 or 2 years after the biopsy [2 accompanying editorial [3], we show that the calculator performs well in our STOP-IgAN patient cohort, even if extended to 96 months after the original trial initiation. However, we also note that the calculator will likely need continuous refinement given the new emerging therapies discussed below.…”

Section: Introductionmentioning

confidence: 84%

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Novel agents for treating IgA nephropathy

Kunter

Seikrit

Floege

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewIn the past, the treatment of IgA nephropathy (IgAN), which is the most common glomerulonephritis worldwide, mostly relied on blockade of the renin–angiotensin system as a central component of so-called supportive therapy as well as on high-dose systemic corticosteroid therapy.Recent findingsThe supportive treatment arm has been expanded by the addition of sodium-glucose cotransporter-2 inhibitors, hydroxychloroquine, and, most recently, endothelin A receptor blockers. Treatment with high-dose systemic corticosteroids has become more controversial, with some studies observing no benefit and others documenting the protection of kidney function. However, all recent studies on systemic corticosteroids consistently found significant toxicity. An important novel approach to IgAN, therefore, is therapy with a targeted release formulation of budesonide with preferential release in the distal small intestine, given the mounting evidence for a gut–kidney axis in the pathophysiology of IgAN. In addition, emerging new therapeutic options include a variety of complement inhibitors as well as agents targeting B-cell proliferation and differentiation.SummaryIn recent years, IgAN has become the focus of a considerable number of clinical studies that will significantly advance the development of new therapy strategies.

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Section: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 84%

Novel agents for treating IgA nephropathy

Kunter

Seikrit

Floege

2023

Current Opinion in Nephrology &Amp; Hypertension

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Section: Proposal For a Therapeutic Strategymentioning

confidence: 99%

“…100 Application of the prediction tool to patients from the STOP-IgA nephropathy trial revealed a significant overlap in risk estimates between patients who had or had not reached the primary composite end point of either 50% eGFR decrease or ESKD. 101 The tool was endorsed by the 2021 Kidney Disease Improving Global Outcomes guidelines to inform patients about their risk of progression, but not to guide the decision to use immunosuppression. 102 Other Biomarkers A high intensity of C3 deposition 103,104 and the presence of C4d deposition 105,106 in the kidney biopsy correlated with an unfavorable clinical outcome, highlighting the importance of complement-induced inflammation.…”

Section: International Iga Nephropathy Prediction Toolmentioning

confidence: 99%

Treatment of IgA Nephropathy: A Rapidly Evolving Field

El Karoui,

Fervenza,

De Vriese

2023

JASN

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The pivotal event in the pathophysiology of IgA nephropathy is the binding of circulating IgA-containing immune complexes to mesangial cells, with secondary glomerular and tubulointerstitial inflammation and fibrosis. The paramount difficulty in the management of IgA nephropathy is the heterogeneity in its clinical presentation and prognosis, requiring an individualized treatment approach. Goal-directed supportive care remains the bedrock of therapy for all patients, regardless of risk of progression. SGLT2 inhibitors and sparsentan should be integral to contemporary supportive care, particularly in patients with chronic kidney damage. Pending the development of reliable biomarkers, it remains a challenge to identify patients prone to progression due to active disease and most likely to derive a net benefit from immunosuppression. The use of clinical parameters, including the degree of proteinuria, the presence of persistent microscopic hematuria and the rate of eGFR loss, combined with the MEST-C score, is currently the best approach. Systemic glucocorticoids are indicated in high-risk patients, but the beneficial effects wane after withdrawal and come at the price of substantial treatment-associated toxicity. Therapies with direct impact on disease pathogenesis are increasingly becoming available. While targeted release budesonide has garnered the most attention, anti-B cell strategies and selective complement inhibition will most likely prove their added value. We propose a comprehensive approach that tackles the different targets in the pathophysiology of IgA nephropathy according to their relevance in the individual patient.

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“…Approximately 30%–40% of IgAN cases progress to end-stage renal disease within 10–20 years after diagnosis, necessitating dialysis or kidney transplantation for life-sustaining treatment. This imposes a significant burden on patients, their families, and society ( Jarrick et al, 2019 ; Floege et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of traditional Chinese medicine versus angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and their combinations in the treatment of IgA nephropathy: a systematic review and network meta-analysis

Ma,

Jiang,

Qian

et al. 2024

Front. Pharmacol.

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Background:IgA nephropathy (IgAN), a condition posing a significant threat to public health, currently lacks a specific treatment protocol. Research has underscored the potential benefits of traditional Chinese medicine (TCM) for treating IgAN. Nevertheless, the effectiveness of various intervention strategies, such as combining TCM with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), lacks a comprehensive systematic comparison. Therefore, this study aimed to conduct a network meta-analysis to assess the clinical efficacy of ACEIs, ARBs, TCM, and their combinations in treating IgAN to offer novel insights and approaches for the clinical management of IgAN.Methods:A systematic review conducted until November 2023 included relevant literature from databases such as PubMed, Embase, Cochrane, Web of Science, Scopus, CNKI, and Wanfang. Two independent researchers screened and assessed the data for quality. Network and traditional meta-analyses were performed using Stata 18.0 and RevMan 5.3 software, respectively. Outcome measures included 24-h urinary protein quantification (24 hpro), estimated glomerular filtration rate (eGFR), serum creatinine (Scr), blood urea nitrogen (BUN), and adverse event incidence rates (ADRs). Forest plots, cumulative ranking probability curves (SUCRA), and funnel plots generated using Stata 18.0 facilitated a comprehensive analysis of intervention strategies’ efficacy and safety.Results:This study included 72 randomized controlled trials, seven interventions, and 7,030 patients. Comparative analysis revealed that ACEI + TCM, ARB + TCM combination therapy, and TCM monotherapy significantly reduced the levels of 24 hpro, eGFR, Scr, and BUN compared to other treatment modalities (p < 0.05). TCM monotherapy demonstrated the most favorable efficacy in reducing eGFR levels (SUCRAs: 78%), whereas the combination of ARB + TCM reduced Scr, 24 hpro, and BUN levels (SUCRAs: 85.7%, 95.2%, and 87.6%, respectively), suggesting that ARB + TCM may represent the optimal intervention strategy. No statistically significant differences were observed among the various treatment strategies in terms of ADR (p > 0.05).Conclusion:The combination of ACEI or ARB with TCM demonstrated superior efficacy compared to ACEI/ARB monotherapy in the treatment of IgAN without any significant ADRs. Therefore, combination therapies can be used to enhance therapeutic outcomes based on individual patient circumstances, highlighting the use of TCM as a widely applicable approach in clinical practice.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023476674.

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Assessing prognosis in IgA nephropathy

Cited by 10 publications

References 9 publications

Novel agents for treating IgA nephropathy

Novel agents for treating IgA nephropathy

Treatment of IgA Nephropathy: A Rapidly Evolving Field

Efficacy of traditional Chinese medicine versus angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and their combinations in the treatment of IgA nephropathy: a systematic review and network meta-analysis

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