IgA-Nephropathy: an update on treatment Jürgen Floege
|
|
- Linette Christal Fisher
- 5 years ago
- Views:
Transcription
1 IgA-Nephropathy: an update on treatment Jürgen Floege Division of Nephrology & Immunology
2 Floege & Feehally, Nat Rev Nephrol 2013 Floege & Eitner, J Am Soc Nephrol If you were my IgAN patient in 2016 No Problem Minor urinay findings, GFR and BP normal (bi-)annual checks for at least 10 years
3 Floege & Feehally, Nat Rev Nephrol 2013 Floege & Eitner, J Am Soc Nephrol If you were my IgAN patient in 2016 No Problem Stratify Risk Minor urinay findings, GFR and BP normal Proteinuria >0.5-1 g/d ± GFR reduced ± hypertension (bi-)annual checks for at least 10 years Supportive therapy optimize for 3-6 months
4 Floege & Eitner, JASN 2011 Floege & Feehally Nat Rev Nephrol 2013 Supportive Therapy of IgA Nephropathy Level 1 Recommendations Control blood pressure (sitting systol. BP in the 120s) ACEI or ARB therapy (uptitrate + maybe combine) Avoid dihydropyridine type calciumchannel-blockers Control protein intake Level 2 Recommendations Restrict NaCl- and fluid-intake, diuretics Non-dihydropyridine type calciumchannel-blockers Control all components of the metabolic syndrome Aldosteronantagonist, ß-blocker Stop smoking Allopurinol Empiric NaHCO 3 therapy, independent of metabolic acidosis ALL As many measures as possible Other measures to retard progression Avoid NSAIDs (max. 1-2 tbl. per week) Avoid severe, prolonged hypokalemia Avoid phosphate-containing laxatives Ergocalciferol to correct vitamin-d deficiency Control hyperphosphatemia and hyperparathyroidism
5 Floege & Feehally, Nat Rev Nephrol 2013 Floege & Eitner, J Am Soc Nephrol If you were my IgAN patient in 2016 No Problem Stratify Risk Minor urinay findings, GFR and BP normal Proteinuria >0.5-1 g/d ± GFR reduced ± hypertension (bi-)annual checks for at least 10 years Supportive therapy optimize for 3-6 months GFR >50 ml/min GFR ml/min GFR 30 ml/min Proteinuria <1 g/d +GFR = Proteinuria 1 g/d ± GFR Supportive therapy critically discuss immunosuppression Supportive therapy No immunosuppress. (except RPGN) Supportive + 6 months corticosteroid Supportive
6 Tesar V et al, J Am Soc Nephrol 2015; 26: VALIGA-Consortium: Corticosteroids in IgAN 1147 European patients of the VALIGA cohort Retrospective analysis (incl. Propensity Score Match) of corticosteroid effects Baseline-GFR 50 ml/min Baseline-GFR >50 ml/min Patients without event (50% GFRreduction or GFR<15 ml/min) p = 0.01 RAS-Blocker only Steroid + RAS-Blocker p = 0.25
7 Trial phase (3 years) Run-in phase (6 months) Eitner F et al, J Nephrol 2008; 21: Trial Design IgAN, years, GFR 30 ml/min, proteinuria > 0,75 g/d PLUS hypertension (> 140/90) or GFR < 90 ml/min Optimized supportive therapy Responder proteinuria < 0,75 g/d optimized supp. therapy; periodically proteinuria Drop-Out proteinuria > 3,5 g/d GFR loss > 30% GFR < 30 ml/min proteinuria 0,75 g/d Non-Responder proteinuria 0,75 g/d Randomization Optimized supportive therapy (SUP) Optim. supp. therapy + immunosuppression (IMM)
8 Rauen T et al, N Engl J Med Dec 4, 2015 Immunosuppression GFR 60 ml/min GFR ml/min Prednisolone initially 40 mg/d tapering to 7,5 mg/d after 6 months Prednisolone 0,5 mg/kg p.o./48h Cyclophosphamide 1,5 mg/kg/d p.o. Azathioprine 1,5 mg/kg/d month month 36 Pozzi et al. Lancet 1999; 353: 883 Ballardie et al., J Am Soc Nephrol 2002; 13:142
9 Rauen T et al, N Engl J Med Dec 4, 2015 Run-in Phase: Blood pressure Non-Responders (proteinuria 0.75 g/d after 6 months) Start of Run-In End of Run-In 27% HTN I 3% HTN II 30% high-normal 15% optimal 25% normal 8% HTN I 21% high-normal 1% HTN II 49% normal 21% optimal < 140/90: 70% 91%
10 Rauen T et al, N Engl J Med Dec 4, Year Trial Phase: Primary End Points SUP events/total IMM OR (95%-CI) p-value In full clinical remission (prot. < 0.2 g/g plus egfr loss < 5 ml/min/1.73 m 2 ) WCS 4/80 14/ ( ) ACA 4/68 14/ ( ) ln favours SUP favours IMM egfr loss 15 ml/min/1.73 m² WCS 24/80 28/ ( ) ACA 16/72 14/ ( ) ln favours IMM favours SUP
11 Mean egfr loss/year (ml/min) Mean egfr loss/year (ml/min) 3-Year Trial Phase: Annual GFR Loss STOP-IgAN (2015) Manno et al. (2009) 0-2 SUP -1.6 IMM Ramipril Steroid + Ramipril
12 Rauen T et al, N Engl J Med Dec 4, Year Trial Phase: Key Safety Data SUP (n=80) IMM (n=82) Patients with at least one SAE Total number of SAEs Total number of infectious events Total number of infectious SAEs 3 8 Death 1 (accident) 1 (sepsis) Malignancy 0 2 Impaired glucose tolerance / diabetes 1 9 Body weight gain ( 5 kg in the first year) 5 14
13 Hong Zh, ERA Congress Vienna 2016 TESTING trial design V1 (-4wks) Register V2 V3 V4 (0m) V5 (1 m) Randomization V6 (3m) V7 (6m) V9 (12m) V13 (24m)-final (every 12 month) Methylprednisolone/matching placebo mg/kg/d (maximal 48mg/d) 2 months tapered at 8mg daily/month Stopped within 6-8 months Final visit- End of Trial ACE inhibitors or ARBs to full dose* blood pressure control as guidelines ACE inhibitors or ARBs to full dose blood pressure control as guidelines ACE inhibitors or ARBs to full dose blood pressure control as guidelines Screening and run-in phase 4 to 12 weeks Placebo Steroids treatment 6-8 months Follow up until 335 events observed Visit every 12 months Sample size: 750 participants, or total 335 primary outcome events 90% power to detect a 30% relative risk reduction for primary outcome Follow-up : 4-6 years
14 Hong Zh, ERA Congress Vienna 2016 Effect on egfr TESTING: egfr Annual egfr slope*: -1.7 vs -6.8 mls/min/1.73m 2 /yr P=0.031 Methylprednisolone Month Mean D p value < Placebo *- defined for each individual patient using the slope from least squares linear regression of all egfr estimates over time 14
15 Hong Zh, ERA Congress Vienna 2016 TESTING: Safety Outcome Methylprednisol one group (N=136) Placebo group (N=126) P Value Total patients with serious adverse events no Serious adverse events of infection 11 0 <.001 Fatal infection 2 0 NS Pneumocystis jirovecii pneumonia 3 0 NS Other lung infection 2 0 NS Septic arthritis 1 0 NS Perianal infection 1 0 NS Gastrointestinal serious adverse events 3 1 NS Bone disorders Avascular necrosis 3 0 NS Fracture 1 0 NS New onset diabetes mellitus 2 3 NS 15
16 TESTING vs STOP-IgAN trial TESTING study STOP-IgAN study Meta-analysis of prior trials Sample size Race Asian 96.3% Caucasian 3.7% Caucasian Age Female (%) 36.7% 21.5% Blood pressure (mmhg) systolic diastolic Proteinuria (g/d) egfr (ml/min/1.73m 2 ) Annual egfr decline in supportive group Annual egfr decline in Steroids group Asian 42% Caucasian 58% RR for Kidney failure 0.36 (0.16 to 0.82) NA 0.32 (0.15 to 0.67) 16
17 Floege & Feehally, Nat Rev Nephrol 2013 Floege & Eitner, J Am Soc Nephrol If you were my IgAN patient in 2016 No Problem Stratify Risk Minor urinay findings, GFR and BP normal Proteinuria >0.5-1 g/d ± GFR reduced ± hypertension (bi-)annual checks for at least 10 years Supportive therapy optimize for 3-6 months GFR >50 ml/min GFR ml/min GFR 30 ml/min Proteinuria <1 g/d +GFR = Proteinuria 1 g/d ± GFR Supportive therapy critically discuss immunosuppression Supportive therapy No immunosuppress. (except RPGN) Supportive + 6 months corticosteroid Supportive?
18 Patients without event (50% GFR-reduction or GFR<15 ml/min) Tesar V et al, J Am Soc Nephrol 2015; 26: VALIGA-Consortium: Corticosteroids in IgAN Mean Proteinuria at Baseline [g/day] < 1 1- <3 3 p = 0.97 p = 0.03 RAS-Blocker only Steroid + RAS-Blocker p = 0.001
19 A few therapeutic approaches of unproven value
20 Pozzi C et al. J Am Soc Nephrol 2010 Therapy of IgA-Nephropathy - Combination Steroid + Azathioprine - Steroid+Aza n=101 6 months Pozzi -scheme additionally azathioprine (1.5 mg/kg) Steroid n=106 6 months Pozzi -scheme Renal function (% patients without 50% increase of s-creatinine) 89% 88% 84% 83% Follow-up (years) No difference in proteinuria Markedly higher side effects of combination therapy
21 Modified after Floege J, Nat Clin Pract Nephrol 2006; 2: 16 Mycophenolate Mofetil Therapy in IgA Nephropathy Country MMF Placebo Baseline S-Crea Proteinuria Histo ACE-I. AT-1 Bl. Outcome MMF vs. Control Belgium n=21 n=12 Maes B et al, Kidney Int 2004 USA n=17 n=15 Frisch G et al, NDT 2005 China n=20 n=20 76% 1.5± ±0.1 85% 2.6± ±0.7 30% 1.5± ±0.2 Tang S et al, Kidney Int 2005 and Kidney Int 2010 USA n=27 n=25 Hogg R et al, Am J Kidney Dis 2015 China n=31 Chen X et al, Zhonghua Yi Xue Za Zhi 2005 n=31 (steroid) 62% Mean egfr 105? 1.9± ± ± ± ± ±0.3 Mean UP/Cr 1.8 g/g grade II-IV Churg 70% grade V Haas 85% grade II-III Haas MEST score mild???? No MMF benefit No MMF benefit Proteinuria reduced GFR stable No MMF benefit Proteinuria reduced + crea stable
22 Fervenza F et al, J Am Soc Nephrol in press A randomized controlled study of rituximab for patients with advanced IgA nephropathy 24hr Proteinuria in Control Group (N = 17) Baseline Day 91 Day 168 Day 258 Day 352 Time (day) 24hr Proteinuria in Ritumab Group (N = 17) Baseline Day 91 Day 168 Day 258 Day 352 Time (day)
23 So, supportive only for everyone?? Maybe there are alternatives
24 Fellstrom B et al, ASN Kongress 2015 NEFIGAN Trial: design RUN-IN PHASE 6 months Optimize RAS Blockade* TREATMENT PHASE 9 months NEFECON 16 mg/day NEFECON 8 mg/day FOLLOW-UP PHASE 3 months 2 week tapering at 8 mg/day 2 week placebo tapering Main Inclusion criteria: 18 years Biopsy-verified IgAN UPCR 0.5 g/g OR Urine protein 0.75 g/day egfr 45 ml/min/1.73m 2 PLACEBO 2 week placebo tapering *Optimized RAS Blockade throughout Treatment and Follow-up Phases
25 Mean (SEM) change from baseline in egfr (ml/min/1.73 m 2 ) Fellstrom B et al, ASN Kongress 2015 NEFIGAN Trial: egfr* NEFECON 8 mg/d Placebo NEFECON 16 mg/d Month Treatment period Follow-up period *egfr estimated with CKD-EPI equation using serum creatinine
26 Floege & Feehally, Nat Rev Nephrol 2013 Floege & Eitner, J Am Soc Nephrol If you were my IgAN patient in 2016 No Problem Stratify Risk Minor urinay findings, GFR and BP normal Proteinuria >0.5-1 g/d ± GFR reduced ± hypertension (bi-)annual checks for at least 10 years Supportive therapy optimize for 3-6 months GFR >50 ml/min GFR ml/min GFR 30 ml/min Proteinuria <1 g/d +GFR = Proteinuria 1 g/d ± GFR Supportive therapy critically discuss immunosuppression Supportive therapy No immunosuppress. (except RPGN) Supportive + 6 months corticosteroid Supportive? Highly proteinuric pts? Nefecon?
27 Floege & Feehally, Nat Rev Nephrol 2013 Floege & Eitner, J Am Soc Nephrol If you were my IgAN patient in 2016 Attention! Acute or rapid loss of GFR Nephrotic syndrome or RPGN AKI (Macrohematuria or other etiology) Supportive therapy Supportive therapy + Immunosuppression
28 Cumulative renal survival [%] IgAN Lv J, et al, J Am Soc Nephrol 2013; 24: Vasculitic IgAN (RPGN-variant) >50% glomerular crescents and RPGN course 113 chinese patients At time of biopsy: 66±16% crescents Crea 4.3±3.4 mg/dl Aggressive immunosuppression (n = 43) Only ESRD predictor: S-creatinine at biopsy No immunosuppr. (n = 70) All patients Months
EVIDENCE BASED TREATMENT OF IgA NEPHROPATHY. Jonathan Barratt
EVIDENCE BASED TREATMENT OF IgA NEPHROPATHY Jonathan Barratt EVIDENCE BASED TREATMENT OF IgA NEPHROPATHY We do not have much evidence EVIDENCE BASED TREATMENT OF IgA NEPHROPATHY We do not have much evidence.
More informationIgA Nephropathy - «Maladie de Berger»
IgA Nephropathy - «Maladie de Berger» B. Vogt, Division de Néphrologie/Consultation d Hypertension CHUV, Lausanne 2011 Montreux CME SGN-SSN IgA Nephropathy 1. Introduction 2. Etiology and Pathogenesis
More informationReducing proteinuria
Date written: May 2005 Final submission: October 2005 Author: Adrian Gillin Reducing proteinuria GUIDELINES a. The beneficial effect of treatment regimens that include angiotensinconverting enzyme inhibitors
More informationCurrent treatment recommendations in children with IgA nephropathy Selçuk Yüksel
Current treatment recommendations in children with IgA nephropathy Selçuk Yüksel Department of Pediatric Nephrology Pamukkale University School of Medicine IgA Nephropathy The most common cause of primary
More informationNephrology Grand Rounds. Mansi Mehta November 24, 2015
Nephrology Grand Rounds Mansi Mehta November 24, 2015 Case 51yo F with PMH significant for Hypertension referred to renal clinic for evaluation of elevated Cr. no known history of CKD; baseline creatinine
More informationChapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, ; doi: /kisup.2012.
http://www.kidney-international.org & 2012 KDIGO Chapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, 172 176; doi:10.1038/kisup.2012.17 INTRODUCTION This
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Blood Pressure Control role of specific antihypertensives
Blood Pressure Control role of specific antihypertensives Date written: May 2005 Final submission: October 2005 Author: Adrian Gillian GUIDELINES a. Regimens that include angiotensin-converting enzyme
More informationAtypical IgA Nephropathy
Atypical IgA Nephropathy Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA XXXIII Chilean Congress of Nephrology, Hypertension and Transplantation Puerto Varas, Chile October 6, 2016 IgA
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Specific management of IgA nephropathy: role of steroid therapy GUIDELINES
Specific management of IgA nephropathy: role of steroid therapy Date written: July 2005 Final submission: September 2005 Author: Merlin Thomas GUIDELINES Steroid therapy may protect against progressive
More informationPredicting and changing the future for people with CKD
Predicting and changing the future for people with CKD I. David Weiner, M.D. Co-holder, C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment
Specific management of IgA nephropathy: role of triple therapy and cytotoxic therapy Date written: July 2005 Final submission: September 2005 Author: Merlin Thomas GUIDELINES a. Triple therapy with cyclophosphamide,
More informationNephrotic Syndrome NS
Nephrotic Syndrome NS By : Dr. Iman.M. Mudawi Pediatric Nephrology Unit Gaafar Ibn Auf Hospital Definitions: In children NS is applied to any condition with a triad of: Heavy proteinuria (UACR ratio >200
More informationIgA Nephropathy: Morphologic Findings Associated with Disease Progression and Therapeutic Response A Working Group Approach
I IgA Nephropathy: Morphologic Findings Associated with Disease Progression and Therapeutic Response A Working Group Approach Mark Haas Department of Pathology & Lab Medicine Cedars-Sinai Medical Center
More informationCase Report Corticosteroids in Patients with IgA Nephropathy and Severe Chronic Renal Damage
Case Reports in Nephrology Volume, Article ID 89, pages doi:.//89 Case Report Corticosteroids in Patients with IgA Nephropathy and Severe Chronic Renal Damage Claudio Pozzi, Francesca Ferrario, Bianca
More informationPRIMARY GLOMERULAR DISEASES
University of Sydney PRIMARY GLOMERULAR DISEASES David Harris 8/2015 Westmead Hospital KDIGO GUIDELINES Steroid-sensitive & resistant nephrotic syndrome in children Minimal-change disease and FSGS in children
More information6/10/2014. Chronic Kidney Disease - General management and standard of care. Management of CKD according to stage (KDOQI 2002)
Chronic Kidney Disease - General management and standard of care Dr Nathalie Demoulin, Prof Michel Jadoul Cliniques universitaires Saint-Luc Université Catholique de Louvain What should and can be done
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Idiopathic membranous nephropathy: use of other therapies GUIDELINES
Idiopathic membranous nephropathy: use of other therapies Date written: July 2005 Final submission: September 2005 Author: Merlin Thomas GUIDELINES No recommendations possible based on Level I or II evidence
More informationHYPERTENSION GUIDELINES WHERE ARE WE IN 2014
HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University
More information1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria
1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage
More informationRandom forest can accurately predict the development of end-stage renal disease in immunoglobulin a nephropathy patients
Original Article Page 1 of 8 Random forest can accurately predict the development of end-stage renal disease in immunoglobulin a nephropathy patients Xin Han 1#, Xiaonan Zheng 2#, Ying Wang 3, Xiaoru Sun
More informationHow I Treat Membranous Nephropathy
How I Treat Membranous Nephropathy Patrick H. Nachman, MD, FASN Marion Stedman Covington Professor May 20, 2017 Treating Membranous Nephropathy: after changes upon changes we are more or less the same
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Specific effects of calcium channel blockers in diabetic nephropathy GUIDELINES
Specific effects of calcium channel blockers in diabetic nephropathy Date written: September 2004 Final submission: September 2005 Author: Kathy Nicholls GUIDELINES a. Non-dihydropyridine calcium channel
More informationChronic Kidney Disease. Paul Cockwell Queen Elizabeth Hospital Birmingham
Chronic Kidney Disease Paul Cockwell Queen Elizabeth Hospital Birmingham Paradigms for chronic disease 1. Acute and chronic disease is closely linked 2. Stratify risk and tailor interventions around failure
More informationStages of Chronic Kidney Disease (CKD)
Early Treatment is the Key Stages of Chronic Kidney Disease (CKD) Stage Description GFR (ml/min/1.73 m 2 ) >90 1 Kidney damage with normal or GFR 2 Mild decrease in GFR 60-89 3 Moderate decrease in GFR
More informationProf. Rosanna Coppo Director of the Nephrology, Dialysis and Transplantation Department Regina Margherita Hospital Turin, Italy. Slide 1.
ROLE OF PATHOLOGY AND CLINICAL FEATURES IN PREDICTING PROGRESSION OF IGA NEPHROPATHY: RESULTS FROM THE ERA-EDTA RESEARCH VALIGA Rosanna Coppo, Turin, Italy Chairs: François Berthoux, Saint-Etienne, France
More informationUpdates in Chronic Kidney Disease Management. Delphine S. Tuot, MDCM, MAS Associate Professor of Medicine UCSF-ZSFG
Updates in Chronic Kidney Disease Management Delphine S. Tuot, MDCM, MAS Associate Professor of Medicine UCSF-ZSFG No disclosures Research Funding: NIH, Blue Shield of California Foundation Objectives
More informationKidney Disease, Hypertension and Cardiovascular Risk
1 Kidney Disease, Hypertension and Cardiovascular Risk George Bakris, MD, FAHA, FASN Professor of Medicine Director, Hypertensive Diseases Unit The University of Chicago-Pritzker School of Medicine Chicago,
More informationManagement of early chronic kidney disease
Management of early chronic kidney disease GREENLANE SUMMER GP SYMPOSIUM 2018 Jonathan Hsiao Renal and General Physician Introduction A growing public health problem in NZ and throughout the world. Unknown
More informationLupus nephritis. Vladimir Tesar Department of Nephrology, General University Hospital, Prague, Czech Republic
Lupus nephritis Vladimir Tesar Department of Nephrology, General University Hospital, Prague, Czech Republic Disclosure of Interests Abbvie, Amgen, Baxter, Bayer, Boehringer-Ingelheim, Calliditas, Chemocentryx,
More informationALLHAT RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR)
1 RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR) 6 / 5 / 1006-1 2 Introduction Hypertension is the second most common cause of end-stage
More informationInterventions to reduce progression of CKD what is the evidence? John Feehally
Interventions to reduce progression of CKD what is the evidence? John Feehally Interventions to reduce progression of CKD what is the evidence? CHALLENGES Understanding what we know. NOT.what we think
More informationManagement and treatment of glomerular diseases KDIGO Controversies Conference Part 1
Management and treatment of glomerular diseases KDIGO Controversies Conference Part 1 Dr.M.Matinfar Assistant Professor of Internal Medicine & Nephrology IUMS -IKRC GENERAL PRINCIPLES IN THE MANAGEMENT
More informationLupus Nephritis New (?) Treatments. Aurélie HUMMEL Service de Néphrologie Hôpital Necker Enfants-Malades Paris
Lupus Nephritis New (?) Treatments Aurélie HUMMEL Service de Néphrologie Hôpital Necker Enfants-Malades Paris Introduction Lupus nephritis : 30-50% of patients with lupus = mortality risk factor Mok Series
More informationDiabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin
Diabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin Disclosures I have no financial relationship with the manufacturers of any commercial product discussed during this
More informationHypertension in Geriatrics. Dr. Allen Liu Consultant Nephrologist 10 September 2016
Hypertension in Geriatrics Dr. Allen Liu Consultant Nephrologist 10 September 2016 Annual mortality (%) Cardiovascular Mortality Rates are Higher among Dialysis Patients 100 10 1 0.1 0.01 0.001 25-34
More informationQUICK REFERENCE FOR HEALTHCARE PROVIDERS
KEY MESSAGES 1 SCREENING CRITERIA Screen: Patients with DM and/or hypertension at least yearly. Consider screening patients with: Age >65 years old Family history of stage 5 CKD or hereditary kidney disease
More informationOffice Management of Reduced GFR Practical advice for the management of CKD
Office Management of Reduced GFR Practical advice for the management of CKD CKD Online Education CME for Primary Care April 27, 2016 Monica Beaulieu, MD FRCPC MHA CHAIR PROVINCIAL KIDNEY CARE COMMITTEE
More informationTHE KIDNEY AND SLE LUPUS NEPHRITIS
THE KIDNEY AND SLE LUPUS NEPHRITIS JACK WATERMAN DO FACOI 2013 NEPHROLOGY SIR RICHARD BRIGHT TERMINOLOGY RENAL INSUFFICIENCY CKD (CHRONIC KIDNEY DISEASE) ESRD (ENDSTAGE RENAL DISEASE) GLOMERULONEPHRITIS
More informationOptimal blood pressure targets in chronic kidney disease
Optimal blood pressure targets in chronic kidney disease Pr. Michel Burnier Service of Nephrology and Hypertension University Hospital Lausanne Switzerland Evidence-Based Guideline for the Management
More informationBlood Pressure Monitoring in Chronic Kidney Disease
Blood Pressure Monitoring in Chronic Kidney Disease Aldo J. Peixoto, MD FASN FASH Associate Professor of Medicine (Nephrology), YSM Associate Chief of Medicine, VACT Director of Hypertension, VACT American
More informationNephrotic syndrome minimal change disease vs. IgA nephropathy. Hadar Meringer Internal medicine B Sheba
Nephrotic syndrome minimal change disease vs. IgA nephropathy Hadar Meringer Internal medicine B Sheba The Case 29 year old man diagnosed with nephrotic syndrome 2 weeks ago and complaining now about Lt.flank
More informationKDIGO GN Guideline update Evidence summary. Steroid-sensitive nephrotic syndrome. Corticosteroid therapy for nephrotic syndrome in children
KDIGO GN Guideline update Evidence summary Steroid-sensitive nephrotic syndrome Corticosteroid therapy for nephrotic syndrome in children PICO question In children (aged 3 to 18 years of age) with steroid-sensitive
More informationEffects of Two Immunosuppressive Treatment Protocols for IgA Nephropathy
Effects of Two Immunosuppressive Treatment Protocols for IgA Nephropathy Thomas Rauen, 1 Christina Fitzner, 2 Frank Eitner, 1,3 Claudia Sommerer, 4 Martin Zeier, 4 Britta Otte, 5 Ulf Panzer, 6 Harm Peters,
More informationOutline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationProf. Armando Torres Nephrology Section Hospital Universitario de Canarias University of La Laguna Tenerife, Canary Islands, Spain.
Does RAS blockade improve outcomes after kidney transplantation? Armando Torres, La Laguna, Spain Chairs: Hans De Fijter, Leiden, The Netherlands Armando Torres, La Laguna, Spain Prof. Armando Torres Nephrology
More informationMetabolic Syndrome and Chronic Kidney Disease
Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference
More informationConsidering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol Patient details Name DOB ESRD Other history Mr. B.I.B. 12 January 1975 (34yo) Membranous GN
More informationDiabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin
Diabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin Disclosures I have no financial relationship with the manufacturers of any commercial product discussed during this
More informationKDIGO Controversies Conference on Glomerular Diseases
KDIGO Controversies Conference on Glomerular Diseases November 16-19, 2017 Singapore Kidney Disease: Improving Global Outcomes (KDIGO) is an international organization whose mission is to improve the care
More informationChapter 6: Idiopathic focal segmental glomerulosclerosis in adults Kidney International Supplements (2012) 2, ; doi: /kisup.2012.
http://www.kidney-international.org chapter 6 & 2012 KDIGO Chapter 6: Idiopathic focal segmental glomerulosclerosis in adults Kidney International Supplements (2012) 2, 181 185; doi:10.1038/kisup.2012.19
More informationManagement of New-Onset Proteinuria in the Ambulatory Care Setting. Akinlolu Ojo, MD, PhD, MBA
Management of New-Onset Proteinuria in the Ambulatory Care Setting Akinlolu Ojo, MD, PhD, MBA Urine dipstick results Negative Trace between 15 and 30 mg/dl 1+ between 30 and 100 mg/dl 2+ between 100 and
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Specific management of IgA nephropathy: role of fish oil
Specific management of IgA nephropathy: role of fish oil Date written: July 2005 Final submission: September 2005 Author: Merlin Thomas GUIDELINES Early and prolonged treatment with fish oil may retard
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Membranous nephropathy role of steroids GUIDELINES
Membranous nephropathy role of steroids Date written: July 2005 Final submission: September 2005 Author: Merlin Thomas GUIDELINES There is currently no data to support the use of short-term courses of
More informationLupus Related Kidney Diseases. Jason Cobb MD Assistant Professor Renal Division Emory University School of Medicine October 14, 2017
Lupus Related Kidney Diseases Jason Cobb MD Assistant Professor Renal Division Emory University School of Medicine October 14, 2017 Financial Disclosures MedImmune Lupus Nephritis Kidney Biopsy Biomarkers
More informationChronic Kidney Disease
Chronic Kidney Disease Chronic Kidney Disease (CKD) Educational Objectives Outline Demographics Propose Strategies to slow progression and improve outcomes Plan for treatment of CKD Chronic Kidney Disease
More informationTread Carefully Because you Tread on my Nephrons. Prescribing Hints in Renal Disease
Tread Carefully Because you Tread on my Nephrons Prescribing Hints in Renal Disease David WP Lappin,, MB PhD FRCPI Clinical Lecturer in Medicine and Consultant Nephrologist and General Physician, Merlin
More informationSpontaneous remission of nephrotic syndrome in patients with IgA nephropathy
Nephrol Dial Transplant (2011) 26: 1570 1575 doi: 10.1093/ndt/gfq559 Advance Access publication 14 September 2010 Spontaneous remission of nephrotic syndrome in patients with IgA nephropathy Seung Hyeok
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. ACE Inhibitor and Angiotensin II Antagonist Combination Treatment GUIDELINES
ACE Inhibitor and Angiotensin II Antagonist Combination Treatment Date written: September 2004 Final submission: September 2005 Author: Kathy Nicholls GUIDELINES No recommendations possible based on Level
More informationLONG-TERM OUTCOME OF PATIENTS WITH LUPUS NEPHRITIS: A SINGLE CENTER EXPERIENCE
& LONG-TERM OUTCOME OF PATIENTS WITH LUPUS NEPHRITIS: A SINGLE CENTER EXPERIENCE Senija Rašić 1 *, Amira Srna 1, Snežana Unčanin 1, Jasminka Džemidžić 1, Damir Rebić 1, Alma Muslimović 1, Maida Rakanović-Todić
More informationCreatinine & egfr A Clinical Perspective. Suheir Assady MD, PhD Dept. of Nephrology & Hypertension RHCC
Creatinine & egfr A Clinical Perspective Suheir Assady MD, PhD Dept. of Nephrology & Hypertension RHCC CLINICAL CONDITIONS WHERE ASSESSMENT OF GFR IS IMPORTANT Stevens et al. J Am Soc Nephrol 20: 2305
More informationSystolic Blood Pressure Intervention Trial (SPRINT)
09:30-09:50 2016.4.15 Systolic Blood Pressure Intervention Trial (SPRINT) IN A NEPHROLOGIST S VIEW Sejoong Kim Seoul National University Bundang Hospital Current guidelines for BP control Lowering BP
More informationMinimal change nephropathy: an update (for adults) Dr. CC Szeto Department of Medicine & Therapeutics The Chinese University of Hong Kong
Minimal change nephropathy: an update (for adults) Dr. CC Szeto Department of Medicine & Therapeutics The Chinese University of Hong Kong First, it is not uncommon Cameron JS. Am J Kidney Dis 10: 157 171,
More informationIntensive Supportive Care plus Immunosuppression in IgA Nephropathy
The new england journal of medicine Original Article Intensive Supportive Care plus in IgA Nephropathy Thomas Rauen, M.D., Frank Eitner, M.D., Christina Fitzner, M.Sc., Claudia Sommerer, M.D., Martin Zeier,
More informationDisclosures. Outline. Outline 5/23/17 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationCARDIO-RENAL SYNDROME
CARDIO-RENAL SYNDROME Luis M Ruilope Athens, October 216 DISCLOSURES: ADVISOR/SPEAKER for Astra-Zeneca, Bayer, BMS, Daiichi-Sankyo, Esteve, GSK Janssen, Lacer, Medtronic, MSD, Novartis, Pfizer, Relypsa,
More informationIgA nephropathy in Greece: data from the registry of the Hellenic Society of Nephrology
Clinical Kidney Journal, 2018, vol. 11, no. 1, 38 45 doi: 10.1093/ckj/sfx076 Advance Access Publication Date: 31 July 2017 Original Article ORIGINAL ARTICLE IgA nephropathy in Greece: data from the registry
More informationOutline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 7/23/2013. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationCKDinform: A PCP s Guide to CKD Detection and Delaying Progression
CKDinform: A PCP s Guide to CKD Detection and Delaying Progression Learning Objectives Describe suitable screening tools, such as GFR and ACR, for proper utilization in clinical practice related to the
More informationClinical Pearls in Renal Medicine
Clinical Pearls in Renal Medicine Joel A. Gordon MD Professor of Medicine Nephrology Division Staff Physician Kidney Disease and Blood Pressure Clinic Disclosures None of my financial holdings will have
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and
More informationPrimary Care Approach to Management of CKD
Primary Care Approach to Management of CKD This PowerPoint was developed through a collaboration between the National Kidney Foundation and ASCP. Copyright 2018 National Kidney Foundation and ASCP Low
More informationA New Approach for Evaluating Renal Function and Predicting Risk. William McClellan, MD, MPH Emory University Atlanta
A New Approach for Evaluating Renal Function and Predicting Risk William McClellan, MD, MPH Emory University Atlanta Goals Understand the limitations and uses of creatinine based measures of kidney function
More informationHypertension targets: sorting out the confusion. Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town
Hypertension targets: sorting out the confusion Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town Historical Perspective The most famous casualty of this approach was the
More informationOutline. Outline 10/14/2014 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationChronic Kidney Disease for the Primary Care Physician in What do the Kidneys do? CKD in the US
1:25-2:25pm Managing Chronic Kidney Disease in 2019 SPEAKERS Adriana Dejman, MD Chronic Kidney Disease for the Primary Care Physician in 2019 Adriana Dejman, MD Assistant Professor of Clinical Medicine
More informationFaculty/Presenter Disclosure
CSI for CKD Unravelling the myths surrounding chronic kidney disease Practical Evidence for Informed Practice Oct 21 2016 Dr. Scott Klarenbach University of Alberta Slide 1: Option B (Presenter with NO
More informationManaging patients with renal disease
Managing patients with renal disease Hiddo Lambers Heerspink, MD University Medical Centre Groningen, The Netherlands Asian Cardio Diabetes Forum April 23 24, 216 Kuala Lumpur, Malaysia Prevalent cases,
More informationAURION STUDY: 48-WEEK DATA OF MULTI-TARGET THERAPY WITH VOCLOSPORIN, MMF AND STEROIDS FOR ACTIVE LUPUS NEPHRITIS
AURION STUDY: 48-WEEK DATA OF MULTI-TARGET THERAPY WITH VOCLOSPORIN, MMF AND STEROIDS FOR ACTIVE LUPUS NEPHRITIS The 12th International Congress on Systemic Lupus Erythematosus (LUPUS 2017) & the 7th Asian
More informationUric acid and CKD. Sunil Badve Conjoint Associate Professor, UNSW Staff Specialist, St George
Uric acid and CKD Sunil Badve Conjoint Associate Professor, UNSW Staff Specialist, St George Hospital @Badves Case Mr J, 52 Male, referred in June 2015 DM type 2 (4 years), HTN, diabetic retinopathy, diabetic
More informationDisclosures. Outline. Outline 7/27/2017 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationNew Treatment Options for Diabetic Nephropathy patients. Prof. M. Burnier, Service of Nephrology and Hypertension CHUV, Lausanne, Switzerland
New Treatment Options for Diabetic Nephropathy patients Prof. M. Burnier, Service of Nephrology and Hypertension CHUV, Lausanne, Switzerland Diabetes and nephropathy Diabetic nephropathy is the most common
More informationTREAT THE KIDNEY TO SAVE THE HEART. Leanna Tyshler, MD Chronic Kidney Disease Medical Advisor Northwest Kidney Centers February 2 nd, 2009
TREAT THE KIDNEY TO SAVE THE HEART Leanna Tyshler, MD Chronic Kidney Disease Medical Advisor Northwest Kidney Centers February 2 nd, 2009 1 ESRD Prevalent Rates in 1996 per million population December
More informationDiabetes and kidney disease.
Diabetes and kidney disease. What are the implications? Can it be prevented? Nice 18 june 2010 Lars G Weiss. M.D. Ph.D. Department of Neprology Central Hospital Karlstad Sweden Diabetic nephropathy vs
More informationSpecial Challenges and Co-Morbidities
Special Challenges and Co-Morbidities Renal Disease/ Hypertension/ Diabetes in African-Americans M. Keith Rawlings, MD Medical Director Peabody Health Center AIDS Arms, Inc Dallas, TX Chair, Internal Medicine
More informationLessons learned from AASK (African-American Study of Kidney Disease and Hypertension)
Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Janice P. Lea, MD, MSc, FASN Professor of Medicine Chief Medical Director of Emory Dialysis ASH Clinical Specialist
More informationEffects of a novel targeted-release formulation of budesonide vs. placebo in. IgA nephropathy: The NEFIGAN randomised clinical trial
1 2 Effects of a novel targeted-release formulation of budesonide vs. placebo in IgA nephropathy: The NEFIGAN randomised clinical trial 3 4 5 6 7 8 9 Authors: Bengt C. Fellstrӧm, Prof, MD, PhD 1, Jonathan
More informationManagement of Hypertension. M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine
Management of Hypertension M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine Disturbing Trends in Hypertension HTN awareness, treatment and control rates are decreasing
More informationT. Suithichaiyakul Cardiomed Chula
T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial
More informationSGLT2 inhibition in diabetes: extending from glycaemic control to renal and cardiovascular protection
SGLT2 inhibition in diabetes: extending from glycaemic control to renal and cardiovascular protection Hiddo Lambers Heerspink Department of Clinical Pharmacy and Pharmacology University Medical Center
More informationSeung Hyeok Han, MD, PhD Department of Internal Medicine Yonsei University College of Medicine
Seung Hyeok Han, MD, PhD Department of Internal Medicine Yonsei University College of Medicine The Scope of Optimal BP BP Reduction CV outcomes & mortality CKD progression - Albuminuria - egfr decline
More informationHenöch Schönlein Purpura nephritis and management. Licia Peruzzi
IPNA-ESPN Junior Master Class Henöch Schönlein Purpura nephritis and management Licia Peruzzi Nephrology Dialysis and Transplantation Regina Margherita Children s Hospital Health and Science University
More informationCase #1. Current Management Strategies in Chronic Kidney Disease. Serum creatinine cont. Pitfalls of Serum Cr
Current Management Strategies in Chronic Kidney Disease Grace Lin, MD Assistant Professor of Medicine, University of California San Francisco Case #1 50 y.o. 70 kg man with long-standing hypertension is
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationAGING KIDNEY IN HIV DISEASE
AGING KIDNEY IN HIV DISEASE Michael G. Shlipak, MD, MPH Professor of Medicine, Epidemiology and Biostatistics, UCSF Chief, General Internal Medicine, San Francisco VA Medical Center Kidney, Aging and HIV
More informationProtocol. This trial protocol has been provided by the authors to give readers additional information about their work.
Protocol This trial protocol has been provided by the authors to give readers additional information about their work. Protocol for: Rauen T, Eitner F, Fitzner C, et al. Intensive supportive care plus
More informationPrevention And Treatment of Diabetic Nephropathy. MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan
Prevention And Treatment of Diabetic Nephropathy MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan Prevention Tight glucose control reduces the development of diabetic nephropathy Progression
More informationThis is the author s final accepted version.
Fellström, B. C. et al. (2017) Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial. Lancet, 389(10084),
More informationCHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More information