9 results on '"Fernandez-Juarez GM"'
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2. EULAR 2023 recommendations for SLE treatment: synopsis for the management of lupus nephritis: the European Renal Association-Immunonephrology Working Group (ERA-IWG) perspective.
- Author
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Frangou E, Bruchfeld A, Fernandez-Juarez GM, Floege J, Goumenos D, Moran SM, Steiger S, Stevens KI, Turkmen K, and Kronbichler A
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- Humans, Europe, Practice Guidelines as Topic, Disease Management, Immunosuppressive Agents therapeutic use, Lupus Nephritis, Nephrology standards, Nephrology methods, Societies, Medical
- Published
- 2024
- Full Text
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3. Management of adult patients with podocytopathies: an update from the ERA Immunonephrology Working Group.
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Mirioglu S, Daniel-Fischer L, Berke I, Ahmad SH, Bajema IM, Bruchfeld A, Fernandez-Juarez GM, Floege J, Frangou E, Goumenos D, Griffith M, Moran SM, van Kooten C, Steiger S, Stevens KI, Turkmen K, Willcocks LC, and Kronbichler A
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- Adult, Humans, Child, Kidney pathology, Glomerulosclerosis, Focal Segmental complications, Nephrosis, Lipoid, Kidney Diseases pathology, Podocytes pathology
- Abstract
The histopathological lesions, minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are entities without immune complex deposits which can cause podocyte injury, thus are frequently grouped under the umbrella of podocytopathies. Whether MCD and FSGS may represent a spectrum of the same disease remains a matter of conjecture. Both frequently require repeated high-dose glucocorticoid therapy with alternative immunosuppressive treatments reserved for relapsing or resistant cases and response rates are variable. There is an unmet need to identify patients who should receive immunosuppressive therapies as opposed to those who would benefit from supportive strategies. Therapeutic trials focusing on MCD are scarce, and the evidence used for the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guideline for the management of glomerular diseases largely stems from observational and pediatric trials. In FSGS, the differentiation between primary forms and those with underlying genetic variants or secondary forms further complicates trial design. This article provides a perspective of the Immunonephrology Working Group (IWG) of the European Renal Association (ERA) and discusses the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases focusing on the management of MCD and primary forms of FSGS in the context of recently published evidence, with a special emphasis on the role of rituximab, cyclophosphamide, supportive treatment options and ongoing clinical trials in the field., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
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- 2024
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4. CKD therapy to improve outcomes of immune-mediated glomerular diseases.
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Anders HJ, Fernandez-Juarez GM, Vaglio A, Romagnani P, and Floege J
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- Humans, Kidney, Renal Insufficiency, Chronic etiology, Renal Insufficiency, Chronic therapy, Glomerulonephritis drug therapy, Glomerulonephritis etiology, Glomerulonephritis, Membranous drug therapy, Glomerulonephritis, IGA
- Abstract
The management of immunoglobulin A nephropathy, membranous nephropathy, lupus nephritis, anti-neutrophil cytoplasmic antibody-associated vasculitis, C3 glomerulonephritis, autoimmune podocytopathies and other immune-mediated glomerular disorders is focused on two major treatment goals, preventing overall mortality and the loss of kidney function. Since minimizing irreversible kidney damage best serves both goals, the management of immune-mediated kidney disorders must focus on the two central pathomechanisms of kidney function decline, i.e., controlling the underlying immune disease process (e.g. with immunotherapies) and controlling the non-immune mechanisms of chronic kidney disease (CKD) progression. Here we review the pathophysiology of these non-immune mechanisms of CKD progression and discuss non-drug and drug interventions to attenuate CKD progression in immune-mediated kidney disorders. Non-pharmacological interventions include reducing salt intake, normalizing body weight, avoiding superimposed kidney injuries, smoking cessation and regular physical activity. Approved drug interventions include inhibitors of the renin-angiotensin-aldosterone system and sodium-glucose cotransporter-2. Numerous additional drugs to improve CKD care are currently being tested in clinical trials. Here we discuss how and when to use these drugs in the different clinical scenarios of immune-mediated kidney diseases., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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5. Management of antineutrophil cytoplasmic antibody-associated vasculitis with glomerulonephritis as proposed by the ACR 2021, EULAR 2022 and KDIGO 2021 guidelines/recommendations.
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Casal Moura M, Gauckler P, Anders HJ, Bruchfeld A, Fernandez-Juarez GM, Floege J, Frangou E, Goumenos D, Segelmark M, Turkmen K, van Kooten C, Tesar V, Geetha D, Fervenza FC, Jayne DRW, Stevens KI, and Kronbichler A
- Subjects
- Humans, Antibodies, Antineutrophil Cytoplasmic, Granulomatosis with Polyangiitis therapy, Churg-Strauss Syndrome, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis complications, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis drug therapy, Microscopic Polyangiitis therapy, Glomerulonephritis drug therapy, Kidney Failure, Chronic etiology, Kidney Failure, Chronic therapy
- Abstract
Updated guidelines on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) were released in 2021 by the American College of Rheumatology jointly with the Vasculitis Foundation and, subsequently, in 2022 by the European Alliance of Associations for Rheumatology. In addition, in 2021, the Kidney Disease: Improving Global Outcomes had released updated recommendations on the treatment of AAV with glomerulonephritis (AAV-GN). Kidney involvement is particularly relevant in microscopic polyangiitis and granulomatosis with polyangiitis, but is less frequent in eosinophilic granulomatosis with polyangiitis. The management of AAV-GN has been a focus for drug development and change over the past 10 years. Avoidance of progression to end-stage kidney disease (ESKD) or kidney failure is one of the main unmet needs in the management of AAV, with ESKD having a major impact on morbidity, health costs and mortality risk. Relevant changes in AAV-GN management are related to remission-induction treatment of patients with severe kidney disease, the use of glucocorticoids and avacopan, and remission-maintenance treatment. All the documents provide guidance in accordance with the evidence-based standard of care available at the time of their release. With our work we aim to (i) show the progress made and identify the differences between guidelines and recommendations, (ii) discuss the supporting rationale for those, and (iii) identify gaps in knowledge that could benefit from additional research and should be revised in subsequent updates., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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6. Prophylactic and early outpatient treatment of COVID-19 in patients with kidney disease: considerations from the Immunonephrology Working Group of the European Renal Association (ERA-IWG).
- Author
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Hilhorst M, Bemelman FJ, Bruchfeld A, Fernandez-Juarez GM, Floege J, Frangou E, Goumenos D, van Kooten C, Kronbichler A, Stevens KI, Turkmen K, Wiersinga WJ, and Anders HJ
- Subjects
- Humans, Antibodies, Viral, Antiviral Agents therapeutic use, Outpatients, SARS-CoV-2, Vaccination, Antibodies, Monoclonal therapeutic use, Antibodies, Neutralizing therapeutic use, COVID-19 prevention & control, Renal Insufficiency, Chronic complications
- Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to rapid vaccine development and large global vaccination schemes. However, patients with immune-mediated kidney disease, chronic kidney diseases and kidney transplant recipients show high non-response rates to vaccination despite more than three vaccinations and, consequently, reduced viral clearance capacity when infected while receiving certain immunosuppressants, carrying an elevated risk for coronavirus disease 2019 (COVID-19)-related morbidity and mortality. SARS-CoV-2 evolution has been characterized by the emergence of novel variants and spike mutations contributing to waning efficacy of neutralizing antibodies. To this end, the therapeutic field expands from vaccination towards a combined approach of immunization, pre-exposure prophylaxis and early post-exposure treatment using direct-acting antivirals and neutralizing monoclonal antibodies to treat early in the disease course and avoid hospitalization. This expert opinion paper from the Immunonephrology Working Group of the European Renal Association (ERA-IWG) summarizes available prophylactic and/or early treatment options (i.e. neutralizing monoclonal antibodies and direct-acting antivirals) of SARS-CoV-2-infected patients with immune-mediated kidney disease, chronic kidney disease and kidney transplant recipients., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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7. Perspective on COVID-19 vaccination in patients with immune-mediated kidney diseases: consensus statements from the ERA-IWG and EUVAS.
- Author
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Stevens KI, Frangou E, Shin JIL, Anders HJ, Bruchfeld A, Schönermarck U, Hauser T, Westman K, Fernandez-Juarez GM, Floege J, Goumenos D, Turkmen K, van Kooten C, McAdoo SP, Tesar V, Segelmark M, Geetha D, Jayne DRW, and Kronbichler A
- Subjects
- Antibodies, Viral, COVID-19 prevention & control, Humans, Mycophenolic Acid therapeutic use, Rituximab therapeutic use, COVID-19 Vaccines adverse effects, COVID-19 Vaccines immunology, Kidney Diseases drug therapy, Kidney Diseases immunology
- Abstract
Patients with immune-mediated kidney diseases are at increased risk of severe coronavirus disease 2019 (COVID-19). The international rollout of COVID-19 vaccines has provided varying degrees of protection and enabled the understanding of vaccine efficacy and safety. The immune response to COVID-19 vaccines is lower in most patients with immune-mediated kidney diseases; either related to immunosuppression or comorbidities and complications caused by the underlying disease. Humoral vaccine response, measured by the presence of antibodies, is impaired or absent in patients receiving rituximab, mycophenolate mofetil (MMF), higher doses of glucocorticoids and likely other immunosuppressants, such as cyclophosphamide. The timing between the use of these agents and administration of vaccines is associated with the level of immune response: with rituximab, vaccine response can only be expected once B cells start to recover and patients with transient discontinuation of MMF mount a humoral response more frequently. The emergence of new COVID-19 variants and waning of vaccine-induced immunity highlight the value of a booster dose and the need to develop mutant-proof vaccines. COVID-19 vaccines are safe, exhibiting a very low risk of de novo or relapsing immune-mediated kidney disease. Population-based studies will determine whether this is causal or coincidental. Such cases respond to standard management, including the use of immunosuppression. The Immunonephrology Working Group and European Vasculitis Society recommend that patients with immune-mediated kidney diseases follow national guidance on vaccination. Booster doses based on antibody measurements could be considered., Competing Interests: The authors have no financial or non-financial potential conflicts of interest to declare related to this project. K.I.S. has received honoraria from Bayer Pharmaceuticals. H.J.A. received honoraria or lecture fees from AstraZeneca, Bayer, Eleva, GlaxoSmithKline, Kezar, Eli Lilly, Novartis, Otsuka, Previpharma and Vifor. A.B. has received honoraria or consulting fees from AstraZeneca, Bayer, ChemoCentryx, Merck/MSD and Vifor. U.S. received honoraria or consulting fees from Ablynx/Sanofi, Alexion Pharma, Allena Pharmaceuticals and Chemocentryx/Vifor. S.P.M. has received honoraria and/or consultancy fees from GlaxoSmithKline, Vifor, Travere and Celltrion. D. Geetha received consulting fees from ChemoCentryx and Aurinia. D.R.W.J. received honoraria or consulting fees from Amgen, Astra-Zeneca, Aurinia, Bristol-Myers Squibb, Boehringer Ingelheim, Chemocentryx, GlaxoSmithKline, National Institute for Health and Care Excellence, Novartis, Otsuka, Roche/Genentech, Takeda, UCB and Vifor. A.K. received honoraria for consulting from Alexion, Otsuka, Catalyst Biosciences, UriSalt, Vifor Pharma and Delta 4 and speaking fees from Vifor Pharma and TerumoBCT. All others report no conflicts of interest related to COVID-19 vaccines., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)
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- 2022
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8. Epigenetic Modulation of Gremlin-1/NOTCH Pathway in Experimental Crescentic Immune-Mediated Glomerulonephritis.
- Author
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Tejedor-Santamaria L, Morgado-Pascual JL, Marquez-Exposito L, Suarez-Alvarez B, Rodrigues-Diez RR, Tejera-Muñoz A, Marchant V, Mezzano S, Lopez-Larrea C, Sola A, Fernandez-Juarez GM, Ortiz A, Rayego-Mateos S, and Ruiz-Ortega M
- Abstract
Crescentic glomerulonephritis is a devastating autoimmune disease that without early and properly treatment may rapidly progress to end-stage renal disease and death. Current immunosuppressive treatment provides limited efficacy and an important burden of adverse events. Epigenetic drugs are a source of novel therapeutic tools. Among them, bromodomain and extraterminal domain (BET) inhibitors (iBETs) block the interaction between bromodomains and acetylated proteins, including histones and transcription factors. iBETs have demonstrated protective effects on malignancy, inflammatory disorders and experimental kidney disease. Recently, Gremlin-1 was proposed as a urinary biomarker of disease progression in human anti-neutrophil cytoplasmic antibody (ANCA)-associated crescentic glomerulonephritis. We have now evaluated whether iBETs could regulate Gremlin-1 in experimental anti-glomerular basement membrane nephritis induced by nephrotoxic serum (NTS) in mice, a model resembling human crescentic glomerulonephritis. In NTS-injected mice, the iBET JQ1 inhibited renal Gremlin-1 overexpression and diminished glomerular damage, restoring podocyte numbers. Chromatin immunoprecipitation assay demonstrated BRD4 enrichment of the Grem-1 gene promoter in injured kidneys, consistent with Gremlin-1 epigenetic regulation. Moreover, JQ1 blocked BRD4 binding and inhibited Grem-1 gene transcription. The beneficial effect of iBETs was also mediated by modulation of NOTCH pathway. JQ1 inhibited the gene expression of the NOTCH effectors Hes-1 and Hey-1 in NTS-injured kidneys. Our results further support the role for epigenetic drugs, such as iBETs, in the treatment of rapidly progressive crescentic glomerulonephritis.
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- 2022
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9. Recommendations for the management of patients with immune-mediated kidney disease during the severe acute respiratory syndrome coronavirus 2 pandemic.
- Author
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Anders HJ, Bruchfeld A, Fernandez Juarez GM, Floege J, Goumenos D, Turkmen K, van Kooten C, Tesar V, and Segelmark M
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- Antiviral Agents, Betacoronavirus, COVID-19, Coronavirus Infections complications, Europe, Humans, Immunosuppressive Agents therapeutic use, Kidney Diseases complications, Pandemics, Pneumonia, Viral complications, Renal Dialysis, Retrospective Studies, Risk Assessment, Risk Factors, SARS-CoV-2, Societies, Medical, Coronavirus Infections immunology, Coronavirus Infections therapy, Kidney Diseases immunology, Kidney Diseases therapy, Nephrology standards, Pneumonia, Viral immunology, Pneumonia, Viral therapy
- Abstract
The coronavirus disease 2019 (COVID-19) pandemic has created major challenges for all countries around the globe. Retrospective studies have identified hypertension, cardiovascular disease, diabetes and older age as risk factors for high morbidity and mortality from COVID-19. There is a general concern that patients with immune-mediated kidney diseases, namely those on immunosuppressive therapies and/or those with more advanced kidney failure, could particularly be at risk for adverse outcomes due to a compromised antiviral immunity. Uncertainties exist on how management routines should be reorganized to minimize the risk of severe acute respiratory syndrome coronavirus 2 infection and what measures are necessary for infected patients. The aim of the present review of the Immunonephrology Working Group of the European Renal Association-European Dialysis and Transplant Association is to provide recommendations for the management of patients with immune-mediated kidney diseases based on the available evidence, similar circumstances with other infectious organisms and expert opinions from across Europe. Such recommendations may help to minimize the risk of encountering COVID-19 or developing complications during COVID-19 in patients with immune-mediated kidney disease., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
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- 2020
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