IWG newsletter

Dear Friends,

Our third newsletter deals with the recent second VALIGA paper dedicated to the impact of immunosuppression on the outcome of patients with IgA nephropathy and reminds you of the CME course organized by the Immunonephrology Working Group  on May 28, 2015 during the 52 ERA-EDTA congress in London.

We are looking forward to meet you during our CME course in London.

Rosanna Coppo,  Chairman of Immunonephrology Working Group
Mohamed R.Daha, Secretary of the Immunonephrology Working Group

Immunonephrology Working Group Newsletter, No. 3, April 2015
1. Corticosteroids may improve the outcome even in patients with IgA nephropathy and impaired renal function

KDIGO 2012 guidelines suggest that patients with IgA nephropathy should be treated with corticosteroids when proteinuria is persistently ≥ 1 g/day despite 3-6 months of supportive care and when eGFR is > 50 ml/min/1.73 m2.   No data from randomized controlled trials are available for the putative efficacy of corticosteroids in patients with eGFR ≤ 50 ml/min/1.73 m2.   Recently published (1) retrospective analysis of data from 1147 patients with IgA nephropathy from the VALIGA  cohort compared the outcome of patients treated (46%) and not treated with immunosuppression (containing in 98% of patients corticosteroids). Not surprisingly patients treated with immunosuppression were characterized by greater clinical and pathologic risk factors of progression, were more often treated with more antihypertensive treatment and higher proportion of them were on renin angiotensin system (RAS) blockade. Despite that immunosuppression was associated with a significant reduction of proteinuria, slower rate of renal function decline and better renal survival.  Using a propensity score, 184 subjects who received corticosteroids and RAS blockade were matched with 184 patients with similar risk profile treated only with RAS blockade.  Patients treated with corticosteroids had more reduced proteinuria and lower rate of renal function decline and increased renal survival. Importantly, the benefits of corticosteroids extended to patients with eGFR eGFR ≤ 50 ml/min/1.73 m2 and increased proportionally with proteinuria.
This retrospective analysis cannot, as stressed by immediate comments (2, 3), replace a randomized controlled trial, but still gives some hope to the patients with IgA nephropathy with impaired kidney function and the potential of corticosteroids to improve the outcome of even advanced IgA nephropathy could be further explored.

1 Tesar V, Troyanov S, Bellur S, Verhave JC, Cook HT, Feehally J, Roberts IS, Cattran D, Coppo R; on behalf of the VALIGA study of the ERA-EDTA Immunonephrology Working Group. Corticosteroids in IgA nephropathy: a retrospective analysis from the VALIGA study. J Am Soc Nephrol 2014; Feb 12. pii: ASN.2014070697 (epub ahead of print)
2 Ponticelli C, Glassock RJ. IgA nephritis with declining renal function: treatment with corticosteroids may be worthwhile. J Am Soc Nephrol 2015; Feb 12. pii: ASN.2015010030 (epub ahead of print)
3 Floege J. Glomerular disease: efficacy of corticosteroids in high-risk IgA nephropathy. Nat Rev Nephrol 2015; Apr 7. doi: 10.1038/nrneph.2015.47 (epub ahead of print)
2. VALIGA long-term follow-up study

As the data collection for VALIGA study ended in 2010 the recruited patients should have now additional five years of follow-up giving its investigators the unique chance to get the long-term follow-up data from this largest ever in the world cohort of 1147 patients with IgA nephropathy. Main investigator of the VALIGA study, Rosanna Coppo, has just asked the participating centres to fill in the questionnaire providing the data on the outcome of these patients.  In the same time VALIGA cohort is planned to be further expanded and genetic, serum and urinary samples of the VALIGA patients (if available) will be potentially used for additional studies.

3. ERA-EDTA supports the new recommendations for the management of ANCA-associated vasculitis

In collaboration with EULAR and ERA-EDTA a group of experts (namely rheumatologists, nephrologists, pathologists) started to prepare new EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis (AAV) which should (among others) reflect the changing paradigm of both induction and maintenance treatment of AAV as a result of especially increased evidence of efficacy of rituximab and increasing experience with its use in clinical practice.

4. IWG CME course „Glomerulonephritis and novel biomarkers“, May 18, London, UK

Immunonephrology Working Group will organize a half-day CME course during the approaching 52nd ERA-EDTA congress in London.  Programme (http://www.era-edta2015.org/en-US/cme-4) is divided into two parts, first symposium will be dedicated to the role of autoantibodies in diagnosis and prognosis assessment in glomerular disease (membranous nephropathy, lupus nephritis, ANCA-associated vasculitis and membranoproliferative glomerulonephritis/C3 nephropathy).  The second symposium will deal with clinical endpoints for clinical trials in glomerular disease (IgA nephropathy, lupus nephritis and membranous nephropathy) with the aim to prepare a position paper on that very important topic.

5. Invitation for proposals

The immunonephrology working group welcomes suggestions from its members for future projects. The working group contains members with a wide variety of experience in clinical, histologic and translational studies in immunopathology and is well placed to advise on the development of projects that would benefit from multicentre international recruitment in Europe. Suggestions should be submitted to the secretary and will be discussed by the Board of the IWG.

Report prepared by Vladimir Tesar