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The article provides an overview of the 2023 recommendations for the treatment of lupus nephritis (LN) from the European Alliance of Associations for Rheumatology (EULAR). The recommendations emphasize the use of belimumab and voclosporin as add-on therapies for managing active LN. Clinical trials have shown that these medications can improve remission rates and reduce kidney damage. The update also discusses the duration of immunosuppression therapy and the potential value of sodium-glucose cotransporter 2 inhibitors as nephroprotective treatment. The future of LN treatment looks promising with the development of newer therapies and the importance of biomarkers in detecting disease activity and response to therapy. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

The Young Nephrologists' Platform (YNP) was established in 2013 by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) to support and involve young nephrologists. The YNP board, made up of members from different regions of Europe and previous winners of the ERA-EDTA Young Nephrologist Award, focuses on education, research, professional development, and leadership opportunities for young physicians and scientists. They have implemented programs such as free membership, an advisory program, and annual medical education courses. The YNP has seen growth in membership and influence, and has made progress in supporting and promoting young nephrologists within the ERA-EDTA community through initiatives like mentorship programs and collaborations with other societies. [Extracted from the article]

Background The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management glomerular/systemic autoimmune diseases with proteinuria in real-world clinical settings is unclear. Methods This is a retrospective, observational, international cohort study. Adult patients with biopsy-proven glomerular diseases were included. The main outcome was the percentage reduction in 24-h proteinuria from SGLT2i initiation to 3, 6, 9 and 12 months. Secondary outcomes included percentage change in estimated glomerular filtration rate (eGFR), proteinuria reduction by type of disease and reduction of proteinuria ≥30% from SGLT2i initiation. Results Four-hundred and ninety-three patients with a median age of 55 years and background therapy with renin–angiotensin system blockers were included. Proteinuria from baseline changed by –35%, –41%, –45% and –48% at 3, 6, 9 and 12 months after SGLT2i initiation, while eGFR changed by –6%, –3%, –8% and –10.5% at 3, 6, 9 and 12 months, respectively. Results were similar irrespective of the underlying disease. A correlation was found between body mass index (BMI) and percentage proteinuria reduction at last follow-up. By mixed-effects logistic regression model, serum albumin at SGLT2i initiation emerged as a predictor of ≥30% proteinuria reduction (odds ratio for albumin <3.5 g/dL, 0.53; 95% CI 0.30–0.91; P  = .02). A slower eGFR decline was observed in patients achieving a ≥30% proteinuria reduction: –3.7 versus –5.3 mL/min/1.73 m2/year (P  = .001). The overall tolerance to SGLT2i was good. Conclusions The use of SGLT2i was associated with a significant reduction of proteinuria. This percentage change is greater in patients with higher BMI. Higher serum albumin at SGLT2i onset is associated with higher probability of achieving a ≥30% proteinuria reduction. [ABSTRACT FROM AUTHOR]

This article discusses the potential benefits of exercise for frail hemodialysis (HD) patients. Frailty is a common concern among HD patients, regardless of age, and can lead to reduced resilience and increased vulnerability to physiological stressors. Physical activity and exercise have been shown to prevent frailty and improve physical performance in older adults. However, many HD patients have low levels of physical activity, which can negatively impact their overall health and well-being. Regular physical activity has been found to have a protective effect on cognitive function and can also be a factor in kidney transplant assessment. Physical performance tools, such as walking speed and balance, can help identify patients who may benefit from physical therapy prior to transplant assessment. Older adults with HD and those with cardiovascular comorbidities or risk factors are less likely to engage in regular physical activity, citing barriers such as pain, fatigue, and concerns about the impact on their health. However, frail HD patients value functional training and are motivated by activities that improve their ability to perform activities of daily living. Exercise programs have been shown to have wide-ranging benefits for HD patients, including reduced mortality and hospitalization rates. Patients who exercise during group HD sessions benefit from peer support and structured home exercise programs can improve cognitive function and encourage social interaction. Exercise programs can be delivered safely without adverse cardiovascular events or increased symptom burden. A study evaluating the impact of exercise programs during HD found that the exercise group showed improvements in lower limb strength and endurance, as well as aerobic fitness, compared to [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]