An anti-nephrin antibody level that flags relapse three months ahead

The edition in brief

An automated chemiluminescence immunoassay for anti-nephrin IgG was tested in 121 children with biopsy-confirmed minimal change disease or primary focal segmental glomerulosclerosis, against disease and healthy controls, with immunoprecipitation-Western blot in parallel. Concordance was 86.8% (kappa 0.714), and the automated assay detected antibody more often than the reference method (41.3% against 28.1%), largely through low-level positives. Among those with nephrotic-range proteinuria at baseline, positivity tracked with more proteinuria, lower albumin and steroid sensitivity. Higher antibody levels predicted shorter relapse-free survival, and positivity during complete remission was associated with relapse within three months, with risk rising by antibody level. A 21-patient open-label randomised study gave empagliflozin 10 mg daily or standard care alone for 10 days to adults with type 2 diabetes, decompensated cirrhosis and refractory ascites. Fractional sodium excretion rose 0.44 percentage points more with treatment (95% CI 0.05-0.83), 24-hour urinary sodium by 92.1 mmol (47.1-137.2), urine volume by 822 mL (403-1240), and mean daily paracentesis volume fell from 1.3 to 0.6 L/day. Ten patients received the drug. In the French DAILY-LUMA cohort of 76 patients with primary hyperoxaluria type 1, 73% met the response criterion at three months. Genotype did not predict response; younger age at diagnosis and at initiation did. Whole-genome sequencing of 1,052 people with congenital anomalies of the kidney and urinary tract gave a monogenic diagnosis in 4.9%.