A calcineurin inhibitor trial may be worth it in children with genetic podocytopathies

The edition in brief

In 136 children with genetic podocytopathies treated with calcineurin inhibitors at 34 paediatric nephrology centres, 28% had at least a partial response at six months; 18% sustained a response throughout, and none of those reached kidney failure over a median 42 months, while non-sustained responders had a 92% lower risk of kidney failure than non-responders. These are retrospective associations, but they challenge the view that these drugs are futile once a genetic cause is found. In a randomised trial of 96 haemodialysis patients, a WeChat-based coaching app improved self-management scores by 13.3 points more than usual care over six months, with better quality of life, mood and potassium and phosphate. A proteomic analysis of 2,485 DAPA-CKD participants found dapagliflozin modified a quarter of the pathways linked to kidney progression, chiefly inflammation and fibrosis, and lowered KIM-1 by 14.9%. A Kidney International commentary describes an African-ancestry variant at the GATM locus that raises creatinine without changing measured GFR.