Management and treatment of glomerular diseases (part 1): conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference

Floege, Jürgen; Barbour, Sean J.; Cattran, Daniel C.; Hogan, Jonathan J.; Nachman, Patrick H.; Tang, Sydney C.W.; Wetzels, Jack F.M.; Cheung, Michael; Wheeler, David C.; Winkelmayer, Wolfgang C.; Rovin, Brad H.

doi:10.36485/1561-6274-2020-24-2-22-41

Cited by 92 publications

(148 citation statements)

References 106 publications

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“…It is unknown if prophylaxis is indicated for all underlying causes of PLN. [12][13][14][15][16] Resistance to both of these drugs is a well-known phenomenon in people, which has resulted in genetic screening and also a need for PFT. 22,[28][29][30][31] To complicate matters, CKD in people also is associated with resistance to antiplatelet treatment and is a consideration for cardiologists and nephrologists when treating patients with a variety of diseases, but in particular cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…13 These diseases are considered major types of glomerulonephritis in people but thromboprophylaxis only is recommended for patients with membranous nephropathy (MN). [14][15][16][17] Specific medications and monitoring are not yet standardized in people with MN, but recently an algorithm has been developed. 16 Similarly, although thromboprophylaxis is advised in dogs with PLN, treatment recommendations and monitoring protocols have not been established.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16][17] Specific medications and monitoring are not yet standardized in people with MN, but recently an algorithm has been developed. 16 Similarly, although thromboprophylaxis is advised in dogs with PLN, treatment recommendations and monitoring protocols have not been established. 10 According to consensus guidelines for standard treatment in PLN dogs, aspirin or clopidogrel is recommended for thromboprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

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Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein‐losing nephropathy

Shropshire

Johnson

Olver

2020

Veterinary Internal Medicne

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Background Dogs with protein‐losing nephropathy (PLN) are treated with antiplatelet drugs for thromboprophylaxis but no standardized method exists to measure drug response. It is also unknown if clopidogrel metabolite concentrations [CM] differ between healthy and PLN dogs. Objectives Assess response to aspirin or clopidogrel in PLN dogs using platelet aggregometry (PA) and compare [CM] between healthy and PLN dogs. Animals Six healthy and 14 PLN dogs. Methods Platelet aggregometry using adenosine diphosphate (ADP), arachidonic acid (AA), and saline was performed in healthy dogs at baseline and 1‐week postclopidogrel administration to identify responders or nonresponders. A decrease of ≥60% for ADP or ≥30% for AA at 1 or 3 hours postpill was used to define a responder. At 1 and 3 hours postclopidogrel, [CM] and PA were measured in healthy and PLN dogs. Platelet aggregometry was performed in PLN dogs at baseline, 1, 6, and 12 weeks after clopidogrel or aspirin administration. Results In PLN dogs receiving clopidogrel, PA differed from baseline at all time points for ADP but not for AA at any time point. Most dogs responded at 1 or both time points except for 1 dog that showed no response. For PLN dogs receiving aspirin, no differences from baseline were observed at any time point for either ADP or AA. No differences in [CM] were found at either time point between healthy and PLN dogs. Conclusions and Clinical Importance Platelet aggregometry may represent an objective method to evaluate response to clopidogrel or aspirin treatment and PLN dogs appear to metabolize clopidogrel similarly to healthy dogs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein‐losing nephropathy

Shropshire

Johnson

Olver

2020

Veterinary Internal Medicne

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“…The therapeutic options of IMN should base on risk stratification, which included proteinuria, serum creatinine, estimated glomerular filtration rate (eGFR), urine IgG and PLA2R antibody levels according to recent Kidney Disease: Improving Global Outcomes controversies conference. 11 For the IMN patients at high risk of progression, immunosuppressive agents should be initiated early. Alkylating agents are recommended to be initial therapy in IMN and remain the only agents proven effective in preventing renal function progression.…”

Section: Introductionmentioning

confidence: 99%

Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Xie

Dong

et al. 2020

Nephrology

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Aim Phospholipase A2 receptor (PLA2R) is a target antigen for idiopathic membranous nephropathy (IMN). However, the association between renal PLA2R antigen and disease prognosis had not been fully investigated. In addition, there was a paucity of studies investigating the difference of therapeutic effects between cyclophosphamide and cyclosporine A in PLA2R‐associated IMN. Methods This retrospective cohort study recruited 300 eligible patients diagnosed with biopsy‐proven IMN between September 2015 and July 2018 in Guangdong Provincial People's Hospital. The remission of proteinuria was compared between PLA2R‐associated and non‐PLA2R‐associated IMN. The difference of therapeutic effects between cyclophosphamide and cyclosporine A were also investigated in PLA2R‐associated IMN. Results The positive rate of renal PLA2R antigen in recruited IMN patients was 82.3%. Non‐PLA2R‐associated IMN patients had a higher probability to achieve remission than PLA2R‐associated IMN patients (Log–rank test, P = .013). Multivariate COX analysis showed that renal PLA2R antigen was an independent risk factor for not achieving remission in IMN patients (Hazard Ratio: 1.619; 95% confidence interval: 1.133 to 2.313; P = .008). In PLA2R‐associated IMN, patients receiving cyclophosphamide had a higher probability to achieve remission compared with those receiving cyclosporine A (Log–rank test, P = .018) while there was no difference in renal survival. Multivariate COX regression analysis showed that compared with cyclosporine A, patients receiving cyclophosphamide had a higher probability to achieve remission. Conclusion Phospholipase A2 receptor ‐associated IMN patients had a lower probability to achieve remission compared with non‐PLA2R‐associated IMN. Compared with cyclosporine A, cyclophosphamide exerted better therapeutic effects in remission of proteinuria and may be the preferred immunosuppressant for PLA2R‐associated IMN.

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“…To date, renin-angiotensin system (RAS) blockade-based supportive care has been the preferred treatment for IgAN, and corticosteroids have been recommended for selected IgAN patients with proteinuria >1.0 g and an estimated glomerular filtration rate (eGFR) >50 ml/min/1.73 m 2 despite supportive therapies based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines [3]. However, in light of the KDIGO Controversies Conference 2017, this recommendation may need to be revisited [4]. More recently, in the Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) study, steroids were shown to be potentially beneficial for clinical remission of IgAN; despite being associated with a significant increase in serious adverse events (SAE) [5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of immunosuppressive agent monotherapy for IgA nephropathy: a network meta-analysis

Han¹,

Yao²,

Lu³

et al. 2020

Preprint

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BackgroundThe efficacy and safety of immunosuppressive agent monotherapy were evaluated for Immunoglobulin A nephropathy (IgAN) using a network meta-analysis approach based on randomised controlled trials (RCTs).MethodsPubMed, Embase, the Cochrane library, and the Web of Science were systematically searched for RCTs published before October 2019 using immunosuppressive agents for treating IgAN. Quality assessments were performed according to the Cochrane Handbook. Pooled relative risks (RRs) or standard mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were calculated for discrete or continuous variables, respectively. The primary outcomes were clinical remission, end-stage renal disease (ESRD), and serious adverse events (SAEs); the secondary outcomes were urinary protein excretion and serum creatinine. Data were synthesised by the random-effects model.ResultsTwenty-five RCTs with 2005 participants were deemed to be eligible, and six medications were evaluated: corticosteroids, mycophenolate mofetil (MMF), tacrolimus (TAC), cyclosporine (CsA), leflunomide (LEF), and hydroxychloroquine (HCQ). Compared to supportive care alone, steroids (RR 1.50, 95% CI 1.17–1.93), MMF (RR 2.05, 95% CI 1.15–3.65), TAC (RR 3.67, 95% CI 1.06–12.63), and HCQ (RR 3.25, 95% CI 1.05–10.09) each significantly improved clinical remission rates; only steroids reduced the risk of ESRD (RR 0.35, 95% CI 0.12–0.98), but the SAEs were significantly higher than those in the control group (RR 2.90, 95% CI 1.37–6.13). Furthermore, steroids, LEF, and HCQ showed lower proteinuria in the pairwise meta-analysis. There was no evidence of different effects of the therapies on serum creatinine levels. The effect of MMF, whereby it induced remission, was reversed when excluding studies with follow-up of fewer than two years in the sensitivity analysis (RR 1.41, 95% CI 0.40–4.92). The anti-proteinuric effect of TAC was reversed three months after discontinuing medication; the long-term effects of HCQ could not be evaluated due to the short follow-up.ConclusionsCorticosteroids might induce remission and increase renal survival in IgAN; however, the adverse reactions should be considered. TAC, LEF, HCQ, and MMF, might improve remission of proteinuria when treating IgAN, but showed no superiority compared to steroids, and the long-term effects require further study.

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Management and treatment of glomerular diseases (part 1): conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference

Cited by 92 publications

References 106 publications

Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein‐losing nephropathy

Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein‐losing nephropathy

Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Efficacy and safety of immunosuppressive agent monotherapy for IgA nephropathy: a network meta-analysis

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