The edition · Nephrology
Iptacopan's slowing of eGFR decline in IgA nephropathy held to four years, and switching from placebo helped too
The APPLAUSE-IgAN extension, early exercise during steroid treatment for nephrotic syndrome, whether crescents predict IgA recurrence after transplant, and a self-management programme for people at risk of diabetic kidney disease.
The edition in brief
In the open-label extension of APPLAUSE-IgAN, patients on iptacopan for up to 48 months had an eGFR slope of −3.49 mL/min/1.73 m² per year with sustained proteinuria reduction (UPCR ratio to baseline 0.61); those switched from placebo saw their slope improve from −5.29 to −2.11 after starting iptacopan. No new safety signals appeared up to five years. A Japanese randomised trial in 27 adults hospitalised with nephrotic syndrome found early exercise improved peak oxygen uptake within the exercise group, though the between-group difference (2.46 mL/kg/min) was not statistically significant, and there was no sign of more non-remission. A cohort and meta-analysis of 311 transplant recipients with IgA nephropathy found crescents on the native biopsy were not significantly associated with recurrence in the graft (RR 1.53, 95% CI 0.40 to 5.90). A Chinese trial in 134 people with type 2 diabetes at high kidney risk found a 12-week self-management programme improved HbA1c, eGFR, blood pressure and LDL, but not albuminuria. The pearl covers optimised supportive care in IgA nephropathy.
Early exercise during steroid treatment for nephrotic syndrome did not raise non-remission
Encourage early mobilisation and structured exercise in adults treated for nephrotic syndrome; the fear that it worsens proteinuria is not supported.
Crescents on the native biopsy did not significantly predict IgA recurrence in the transplanted kidney
Do not use native-biopsy crescents alone to counsel patients with IgA nephropathy about recurrence risk after transplant.
A self-management programme improved eGFR, HbA1c and blood pressure in people at high diabetic kidney risk
Add structured self-management education for people with type 2 diabetes at high risk of kidney disease, alongside SGLT2 inhibitors and RAS blockade.
Optimise supportive care before adding targeted therapy in IgA nephropathy
Ensure maximal tolerated RAS blockade and blood pressure control in every patient with IgA nephropathy and proteinuria, and consider an SGLT2 inhibitor where eGFR allows.
Iptacopan's slowing of eGFR decline in IgA nephropathy was sustained to four years
For IgA nephropathy with persistent proteinuria despite optimised supportive care, iptacopan is an option where available, and benefit appears durable.
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