IWG newsletter

   
Dear Friends,

In this fifth newsletter of Immunonephrology Working Group (IWG), we would like to inform you of the upcoming CME course of IWG which will be held in Vienna on May 21, between 09.00 am and 12.15 pm at Hall E and also introduce you our new board members. Moreover, we would like to inform you of the upcoming joint meeting of IWG which will be held in Tours on September 15-17, 2016. You will also find updates from the recently published articles on the immune-mediated renal diseases.

We are looking forward to meeting you during our CME courses. We would also like to invite you to kindly encourage your colleagues interested in research, teaching, communication and education in the field of immuno-mediated renal diseases to become an IWG Member.

With kind regards,

Vladimir Tesar,  Chairman of Immunonephrology Working Group
Mårten Segelmark, Secretary of the Immunonephrology Working Group
Immunonephrology Working Group Newsletter, No. 5, May 2016
   
1. Upcoming joint meetings and CME courses

IWG CME course, 53rd ERA-EDTA Congress, Vienna, Austria on May 21, 2016
It is a great pleasure and honour for us to invite you to 53rd ERA-EDTA Congress, Vienna to attend the CME course of IWG “News in the diagnostics and treatment of glomerular diseases”.
CME 1
09.00-12.15 HALL E

News in the diagnostics and treatment of glomerular disease

Critical review of renal biopsy

Indications for renal biopsy: when it is needed?
Loreto Gesualdo, Bari, Italy
Evidence based classification of renal pathology
Ian Roberts, Oxford, United Kingdom
Can biomarkers substitute renal biopsy in IgA nephropathy?
Yasar Caliskan, Istanbul, Turkey
What is the added value of renal biopsy and rebiopsy to clinical data in lupus
Gabriella Moroni, Pavia, Italy
What is the added value of renal biopsy to clinical data in vasculitis
Ingeborg M. Bajema, Leiden, The Netherlands

4 years after the KDIGO guidelines on glomerular diseases: when to update them?


Membranous nephropathy
Jack F.M. Wetzels, Nijmegen, The Netherlands
IgA nephropathy
Jürgen Floege, Aachen, Germany
FSGS/minimal change disease
Rosanna Coppo, Turin, Italy
Lupus nephritis
David Jayne, Cambridge, United Kingdom
ANCA-associated vasculitis
Vladimir Tesar, Prague, Czech Republic

Symposium on IgA Nephropathy, Tours, France on September 15-17, 2016
The focus of this 14th International Symposium on IgA Nephropathy will be “Pathogenesis, Biomarkers and Therapeutic Innovation”. The symposium is organized through the IgA Nephropathy Network and IWG Board Members. You can access the symposium scientific program online: http://iigann-tours-2016.com/program

2. News from IWG Board

Two Ordinary Board Members Sandrine Florquin (The Netherlands) and David Jayne (United Kingdom) will be ending their term in the IWG Board.
We thank them for their great contribution and service for IWG !

The IWG board elected two new members from five candidates who submitted their intention to serve as board members of the IWG for the next three years.
The newly elected IWG board members are:
• Hans-Joachim Anders (Munich, Germany)
• Giuseppe Grandaliano (Bari, Italy)
We congratulate our new board members !

IWG board member “Rosanna Coppo” is awarded as the recipient of 2016 ERA-EDTA Award for Outstanding Contributions to Nephrology. During her successful career Rosanna Coppo trained numerous nephrologists and pediatricians but also she contributed to establish the education of nephrology on institutional level what makes this award very well deserved.
We congratulate Rosanna Coppo and thank her for great contribution to Nephrology !

3. Updates from recent publications

IgA Nephropathy (IgAN)
Let us start with the last VALIGA study paper in collaboration with Oxford Derivation and North American Validation Study groups entitled “The MEST score provides earlier risk prediction in IgA nephropathy” recently published in Kidney Int, 2016 January. Searching for predictors of IgAN prognosis still has central importance in clinical research. In this study, Barbour et al. assessed whether adding biopsy findings to clinical parameters obtained at first presentation improves the predictive power by using three large IgAN cohorts. Probably the most important finding of this study is that adding MEST parameters to cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.

Although the absence of IgA1 and CD89 homologs in the mouse has precluded in vivo proof-of-concept studies of specific therapies targeting IgA1 in IgAN. A promising study from Renato Monteiro’s group “IgA1 Protease Treatment Reverses Mesangial Deposits and Hematuria in a Model of IgA Nephropathy” was recently published in J Am Soc Nephrol 2016 February. A recombinant IgA1 protease (IgA1‑P), a bacterial protein that selectively cleaves human IgA1 was shown to strongly diminish human IgA1 mesangial deposits and reduce inflammation, fibrosis, and hematuria in a mouse IgAN model. They concluded that IgA1‑P may be a plausible treatment for patients with IgAN.

Glomerular Pathology
The area of glomerulonephritis (GN) histopathology has been further addressed by the recently published paper from Sethi et al “Mayo Clinic/Renal Pathology Society Consensus Report on Pathologic Classification, Diagnosis, and Reporting of GN” in J Am Soc Nephrol, 2016 May. The need for an etiology/pathogenesis based classification of glomerulonephritis was addressed by a group of renal pathologists and nephrologists, in February 2015 with the support of Mayo Clinic/Renal Pathology Society to develop a consensus-based etiology/pathogenesis-oriented classification of GN and harmonize the pathological reporting guidelines for GN. In this consensus report, they emphasized a pathogenesis-based classification of GN and provided guidelines for the standardized reporting of GN.

Focal Segmental Glomerulosclerosis (FSGS)
The Nephrotic Syndrome Study Network (NEPTUNE) is a North American multicenter collaborative consortium established to develop a translational research infrastructure for nephrotic syndrome. A recent study from NEPTUNE cohort including 441 patients was reported recently by Gipson et al. entitled “Complete Remission in the Nephrotic Syndrome Study Network” in Clin J Am Soc Nephrol 2016 January. Gipson et al highlighted the value of the diagnostic kidney biopsy. They also found that proteinuria level before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission. Another important FSGS study regarding treatment is “Treatment with Glucocorticoids or Calcineurin Inhibitors in Primary FSGS” by Laurin et al published in Clin J Am Soc Nephrol, 2016 March. They evaluated 458 patients and found that immunosuppressive therapy with glucocorticoids and/or calcineurin inhibitors was associated with better renal survival than no immunosuppression. The results of calcineurin inhibitors with or without glucocorticoids were not significantly differ regarding the development of end stage renal disease.

Mebranous Nephropathy (MN)
Extensive search in the field of biomarkers for MN resulted the discovery of serum phospholipase A2 receptor antibodies. In a recent paper “Combined Assessment of Phospholipase A2 Receptor Autoantibodies and Glomerular Deposits in Membranous Nephropathy” published in J Am Soc Nephrol 2016 March, Qin et al showed the superiority of combining the measurements of serum phospholipase A2 receptor antibody levels and detection of glomerular phospholipase A2 receptor deposition in providing additional information regarding diagnoses, treatment response, and disease relapse in patients with primary MN.

Another important paper entitled “Patients with primary membranous nephropathy are at high risk of cardiovascular events” was recently published in Kidney Int 2016 May. Lee et al reported the increased risk of cardiovascular events in a discovery cohort of 404 patients and also affirmed these results in an external validation cohort of 557 patients with primary MN. The authors suggested that reduction of cardiovascular events should be considered as a therapeutic outcome measure and focus of intervention in primary MN.

ANCA Associated Vasculitis (AAV)
An important paper regarding vasculitis is a recent study from MAINRITSAN cohort published in Clin Exp Rheumatol by Pugnet et al and entitled “Rituximab versus azathioprine for ANCA-associated vasculitides maintenance therapy: impact on global disability and health-related quality of life”. Pugnet et al investigated the effects on health-related quality of life (HRQOL) and functional capability of rituximab vs azathioprine for AAV maintenance therapy. They concluded that azathioprine-treated patients' for AAV maintenance therapy showed a decline in physical abilities when compared to rituximab at month 24 in the MAINRITSAN trial.

Lupus Nephritis

New research that may dramatically improve drug development for systemic lupus erythematosus patients entitled “Personalized Immunomonitoring Uncovers Molecular Networks That Stratify Lupus Patients" is recently published online in Cell, 2016 April. Banchereau et al studied the transcription of genes in 924 blood samples from 158 pediatric lupus patients from Texas Scottish Rite Hospital for Children clinics and other children's hospitals for up to four years. This personalized immunomonitoring approach, which measures gene expression activity of different cell types, allowed researchers to classify patients into seven groups with similar molecular disease structure at the time of both disease flares and remissions.

Complement mediated glomerulonephritis
Finally, Sethi et al described a novel complement-mediated glomerulonephritis “C4 glomerulopathy” which is characterized by bright glomerular C4d staining with minimal or absent staining for C1q, C3, and immunoglobulin in their recent paper “C4 Glomerulopathy: A Disease Entity Associated With C4d Deposition” published recently in Am J Kidney Dis 2016 February.

• Barbour SJ, Espino-Hernandez G, Reich HN et al; Oxford Derivation, North American Validation and VALIGA Consortia; Oxford Derivation North American Validation and VALIGA Consortia. The MEST score provides earlier risk prediction in lgA nephropathy. Kidney Int 2016; 89(1): 167-75.
• Lechner SM, Abbad L, Boedec E et al. IgA1 Protease Treatment Reverses Mesangial Deposits and Hematuria in a Model of IgA Nephropathy. J Am Soc Nephrol 2016 Feb 5.
• Sethi S, Haas M, Markowitz GS et al. Mayo Clinic/Renal Pathology Society Consensus Report on Pathologic Classification, Diagnosis, and Reporting of GN. J Am Soc Nephrol 2016; 27(5): 1278-87.
• Gipson DS, Troost JP, Lafayette RA et al. Complete Remission in the Nephrotic Syndrome Study Network (NEPTUNE). Clin J Am Soc Nephrol 2016; 11(1): 81-9.
• Laurin LP, Gasim AM, Poulton CJ et al. Treatment with Glucocorticoids or Calcineurin Inhibitors in Primary FSGS. Clin J Am Soc Nephrol 2016; 11(3): 386-94.
• Qin HZ, Zhang MC, Le WB et al. Combined Assessment of Phospholipase A2 Receptor Autoantibodies and Glomerular Deposits in Membranous Nephropathy. J Am Soc Nephrol 2016 Mar 17.
• Lee T, Derebail VK, Kshirsagar AV et al. Patients with primary membranous nephropathy are at high risk of cardiovascular events. Kidney Int 2016; 89: 1111-8.
• Pugnet G, Pagnoux C, Terrier B et al. Rituximab versus azathioprine for ANCA-associated vasculitides maintenance therapy: impact on global disability and health-related quality of life. Clin Exp Rheumatol 2016 Mar 25.
• Banchereau R, Hong S, Cantarel B et al. Personalized Immunomonitoring Uncovers Molecular Networks that Stratify Lupus Patients. Cell 2016; 165(3): 551-65.
• Sethi S, Quint PS, O'Seaghdha CM et al. C4 Glomerulopathy: A Disease Entity Associated With C4d Deposition. Am J Kidney Dis 2016 Feb 17.

Report prepared by Yasar Caliskan, Co-editor of IWG Newsletter