The edition · Nephrology
Iptacopan's slowing of IgA nephropathy held to four years, and switching from placebo slowed decline too
Extension data support complement inhibition in IgA nephropathy, crescents did not predict recurrence after transplant, H. pylori eradication tracks with less proteinuria, and early exercise in nephrotic syndrome showed no sign of harm.
The edition in brief
In the open-label extension of APPLAUSE-IgAN (Kidney International, 22 October), patients on iptacopan for up to 48 months had an eGFR slope of −3.49 mL/min/1.73 m² per year with proteinuria about 39% below baseline; those switched from placebo saw their slope improve from −5.29 to −2.11. No new safety signals emerged. A cohort and meta-analysis of 311 transplanted patients with IgA nephropathy (Journal of Nephrology, 22 October) found native-biopsy crescents were not significantly associated with recurrence in the graft (RR 1.53, 95% CI 0.40 to 5.90). A meta-analysis of 16 studies (Journal of Nephrology, 30 October) linked H. pylori eradication to lower proteinuria, with very high heterogeneity and observational data for kidney outcomes. A 27-patient randomised trial of early exercise in adults hospitalised with nephrotic syndrome (Journal of Nephrology, 22 October) found no excess non-remission and a non-significant gain in fitness. The pearl covers sick-day medication rules in CKD.
Iptacopan's effect on kidney decline in IgA nephropathy held through four years
Iptacopan's slowing of eGFR decline in IgA nephropathy was sustained to four years, alongside supportive care.
Crescents in the native biopsy did not clearly predict IgA nephropathy recurrence after transplant
Native-biopsy crescents in IgA nephropathy did not clearly predict recurrence after kidney transplant.
H. pylori eradication was associated with lower proteinuria
Where H. pylori is found in proteinuric kidney disease, eradicate it; the kidney benefit is suggestive, not proven.
Sick-day rules for patients with CKD
Teach patients with CKD which medicines to pause during vomiting, diarrhoea or poor intake, and when to restart.
Early exercise in nephrotic syndrome did not worsen remission in a small trial
Consider encouraging graded exercise in nephrotic syndrome; this small trial found no harm to remission.
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