n. 9, September 2018


Dear colleagues,


In this ninth newsletter of the Immunonephrology Working group (IWG), you will find some updates from the 55th ERA-EDTA Congress in Copenhagen (Denmark), an introduction of new board members, as well as an update of recently published clinical results in the field of Immunonephrology.


We wish you all the best this late summer time.


With kind regards


Vladimir Tesar, Chairman

Marten Segelmark, Vice Chair


Cees van Kooten, newsletter co-editor

Yasar Caliskan, newsletter co-editor



During the IWG Board meeting held in Copenhagen at the ERA-EDTA Congress, several Board members were at the end of their term. Rosanna Coppo (Italy), Mohamed Daha (The Netherlands), Renato Monteiro (France), Jack Wetzels (The Netherlands) and Yasar Caliskan (Turkey). The Board is very grateful for their efforts and continuous input to make the IWG a success. Three vacancies for the Board have been announced and the following new members were elected:

Dimitrios Goumenos (Greece)

Gemma Maria Fernandez (Spain)

Kültigin Turkmen (Turkey)


At the 55th ERA-EDTA Congress in Copenhagen, the IWG Board members met with representatives of the Japanese Society of Nephrology. The results of the joint survey for the indications for biopsies in IgAN were discussed and it was decided to extend this analysis. A new survey has been sent out and IWG ordinary members and colleagues have the possibility to participate until October 1, 2018.

Click here to join the survey.




How to become your local expert in Nephrogenetics

October 8 and 9, 2018

Belgrade (Serbia)

This event is jointly organised by the Young Nephrologists' Platform (YNP), the Immunonephrology Working Group (IWG), the Working Group on Inherited Kidney Diseases (WGIKD) and the ERA-EDTA Ethics Committee, in collaboration with ERKnet.


Click here to download the preliminary programme.

Registration is NOW open.


The ERA-EDTA offers EUR 2,500 in travel grants to nephrologists who are 40 years old or younger, plus one year ERA EDTA membership (to young persons who have never  been  members  of  ERA EDTA  ONLY). Click here to learn about travel grant opportunities.



The IWG Board warmly suggests the following educational event:

IIgANN2018 – International Symposium on IgANephropathy

Buenos Aires (Argentina), September 27-29, 2018


Update from the 55th ERA-EDTA Congress (May 24-27, 2018 - Copenhagen, Denmark)


The two IWG sessions organised at the 55th ERA-EDTA Congress in Copenhagen on “Cyclophosphamide in glomerular disease: is this old drug still to be used or does it have to be dismissed?” and “Renal involvement in rare inflammatory diseases” respectively reached over 1000 attendees and therefore were amongst the best visited sessions.


In the late breaking clinical abstracts Michael Walsh (Hamilton, Canada) presented the results of the PEXIVAS trial. In this trial, a multicentre, open-label randomised controlled trial with a 2x2 design including over 700 patients with ANCA associated vasculitis (AAV). It was shown that plasma exchange does not reduce the risk for end-stage renal disease or death. When comparing two different doses of glucocorticoids, it was found that the reduced dose GC (<60% of standard dose) was not inferior to the standard dose GC, but did result in less severe rejections. Results of the trial were intensely discussed during the meeting.

David Jayne (Cambridge, UK) presented the results of the ALLURE trial, a phase 3 trial comparing abatacept, a modulator of T cell costimulation with placebo in over 400 patients with class III and class IV lupus nephritis. The primary end point of complete response at year one was not improved by abatacept (35,1 vs 33,5 %). Nevertheless, major differences were seen on immune markers including reduction of anti-dsDNA antibodies.

We look forward to the publication of these studies to learn further details.



Updates from recent publications



Naritati et al (2018) Arthritis & Rheumatology 70:109-114

This study describes 22 patients with adult onset IgA vasculitis (IgAV)(Henoch Schönlein) who were included to investigate the effect of rituximab (RTX) treatment. 16 patients received RTX as add-on, 6 patients received it as mono-therapy. Within the whole group 90% showed remission, however but of these 7 of these showed a subsequent relapse. Treatment resulted in significant reduction in proteinuria, CRP levels, BVAS score and use of prednisone. The therapy was well tolerated. It was concluded that RTX is a therapeutic option for patients with adult onset IgAV.



Kraaij et al (2018) J of Autoimm 91:45-54

16 patients with severe refractory SLE were included in the SYNBIOSE study, a phase 2a open label study, investigating the combined treatment of B cell depletion with rituximab and inhibition of B cell growth factor Blys using belimumab. This combined treatment appeared to be safe and clinical response was achieved concomitant with tapering of immunosuppressive medication (reduction of corticosteroids and discontinuation of MMF). Therapy resulted in the specific reduction of various autoantibodies, while at the same time preserving titers of some protective antibodies. Moreover, combined treatment of these patients resulted in a strong reduction of NETosis-inducing activity, a mechanism of neutrophil cell death with expulsion of immunogenic DNA, implicated in the pathogenesis of SLE.


Gomez Mendez et al (2018) CJASN 13 (online August 8)

Patients from the rituximab arm of the LUNAR trial were analysed for the relation between B cell depletion and clinical response. These 68 patients received a B cell depletion regimen with 4 injections of rituximab at day 1, 15, 168 and 182. When analysed at 1 year, 22% of patients showed incomplete depletion of B cells as defined according to the stringent criteria of >0 cells/ml. On the other hand, 78% of patients did show  a complete depletion of CD19+ B cells. In this group the complete clinical response at week 78, defined as a urine protein:creatinine ratio <0.5 and normal serum creatinine, was 47%, and thereby significantly higher than the 13% in the group with incomplete B cell depletion (odds ratio 5.8). These results suggest an added value of B cell monitoring to determine the degree of B cell depletion.



Charles et al (2018) Ann Rheum Dis 77:1143-1149

Patients with newly diagnosed or relapsing AAV (both GPA and MPA), in complete remission after induction therapy, were included in the MAINRITSAN2 trial. In total, 163 patients were randomised in one arm receiving a fixed-scheduled rituximab (RTX) infusion and a tailored RTX infusions in the other, based on recurrence of CD19+ B cells or increase of ANCA titers. The primary end point of the study was the number of relapses or worsening of the BVAS score at month 28. There was no significant difference in the relapse rate between both regimen. For patients within the tailored arm, this was received with fewer RTX infusions.


McAdoo et al (2018) Nephrol Dial Transplant (online February 14)

A long term follow up of a single-centre cohort of 66 patients with AAV treated with the combination of rituximab and cyclophosphamide was reported. Median follow up time was 56 months. Of these patients, 94% achieved disease remission and patient and renal survival was 84% and 95% respectively at 5 years. The rate of serious infections during long-term follow up was 1.24 per 10 patients years. When compared with results from the EUVAS trials, these results appeared superior and it is concluded that a controlled study to look into this combined treatment could be warranted.

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