Board Review Bonus #1: IgA Nephropathy

GN in Ten

SHOW NOTES

In this episode, Koyal and Kenar recap everything you need to know about IgAN for the board exam (or just to refresh yourself on the current state of knowledge) — from pathophysiology to treatment decisions. They also discover that nobody is really sure how to pronounce Peyer’s patches (hey, don’t blame us, they’re all the way over in the ileum) so make sure you read the show notes to settle that mystery and check out additional resources!

Board Review Bonus #1 - IgA Nephropathy

Online calculator to predict progression (International IgAN Prediction Tool at biopsy - Adults)

https://qxmd.com/calculate/calculator_499/international-igan-prediction-tool-at-biopsy-adults

Inflammatory bowel disease and IgAN:

Rehnberg J, Symreng A, Ludvigsson JF, Emilsson L. Inflammatory Bowel Disease Is More Common in Patients with IgA Nephropathy and Predicts Progression of ESKD: A Swedish Population-Based Cohort Study. J Am Soc Nephrol. 2021 Feb;32(2):411-423. doi: 10.1681/ASN.2020060848. Epub 2020 Nov 11. PMID: 33177116; PMCID: PMC8054887.

MEST-C (Oxford classification):

Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, Liu ZH, Roberts IS, Yuzawa Y, Zhang H, Feehally J; IgAN Classification Working Group of the International IgA Nephropathy Network and the Renal Pathology Society; Conference Participants. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017 May;91(5):1014-1021. doi: 10.1016/j.kint.2017.02.003. Epub 2017 Mar 22. PMID: 28341274.

DAPA-CKD:

Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, Mann JFE, McMurray JJV, Lindberg M, Rossing P, Sjöström CD, Toto RD, Langkilde AM, Wheeler DC; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8;383(15):1436-1446. doi: 10.1056/NEJMoa2024816. Epub 2020 Sep 24. PMID: 32970396.

EMPA-Kidney:

The EMPA-KIDNEY Collaborative Group; Herrington WG, Staplin N, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Judge P, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu W, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Massey D, Eilbracht J, Brueckmann M, Landray MJ, Baigent C, Haynes R. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023 Jan 12;388(2):117-127. doi: 10.1056/NEJMoa2204233. Epub 2022 Nov 4. PMID: 36331190; PMCID: PMC7614055.

STOP-IgAN trial:

Rauen T, Eitner F, Fitzner C, Sommerer C, Zeier M, Otte B, Panzer U, Peters H, Benck U, Mertens PR, Kuhlmann U, Witzke O, Gross O, Vielhauer V, Mann JF, Hilgers RD, Floege J; STOP-IgAN Investigators. Intensive Supportive Care plus Immunosuppression in IgA Nephropathy. N Engl J Med. 2015 Dec 3;373(23):2225-36. doi: 10.1056/NEJMoa1415463. PMID: 26630142.

TESTING trial:

Lv J, Wong MG, Hladunewich MA, Jha V, Hooi LS, Monaghan H, Zhao M, Barbour S, Jardine MJ, Reich HN, Cattran D, Glassock R, Levin A, Wheeler DC, Woodward M, Billot L, Stepien S, Rogers K, Chan TM, Liu ZH, Johnson DW, Cass A, Feehally J, Floege J, Remuzzi G, Wu Y, Agarwal R, Zhang H, Perkovic V; TESTING Study Group. Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial. JAMA. 2022 May 17;327(19):1888-1898. doi: 10.1001/jama.2022.5368. PMID: 35579642; PMCID: PMC9115617.

Phase 3 trial of targeted-release budesonide (NefIgArd):

Barratt J, Lafayette R, Kristensen J, Stone A, Cattran D, Floege J, Tesar V, Trimarchi H, Zhang H, Eren N, Paliege A, Rovin BH; NefIgArd Trial Investigators. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int. 2023 Feb;103(2):391-402. doi: 10.1016/j.kint.2022.09.017. Epub 2022 Oct 19. PMID: 36270561.

MAIN trial:

Hou FF, Xie D, Wang J, Xu X, Yang X, Ai J, Nie S, Liang M, Wang G, Jia N; MAIN Trial Investigators. Effectiveness of Mycophenolate Mofetil Among Patients With Progressive IgA Nephropathy: A Randomized Clinical Trial. JAMA Netw Open. 2023 Feb 1;6(2):e2254054. doi: 10.1001/jamanetworkopen.2022.54054. PMID: 36745456.

A note on pronunciation: We dug a little deeper after recording this, and following the people they’re named after, Jean Berger (a French speaker) and Johann Conrad Peyer (a German speaker), “Berger” should rhyme with “hooray” and “Peyer” should rhyme with “fire.” The more you know!

Disclosures:

ISGD receives general financial support from Boehringer Ingelheim, Travere Therapeutics, and Calliditas Therapeutics, among other companies, through corporate partnerships. None of these entities was involved in or had any influence on the content or editing of this episode.

Koyal Jain serves as principal site investigator for Kaneka’s FSGSALLAGE (NCT04065438) and FSGS Pediatric (NCT02235857) clinical trials.

Kenar Jhaveri is the National Scientific Lead for Otsuka's VISIONARY trial for IgA Nephropathy, and serves as a consultant for Otsuka, Novartis, and Calliditas.