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Sean Barbour, John Feehally
PURPOSE OF REVIEW: The treatment of IgA nephropathy (IgAN) has been limited by several controversies in the literature, including the benefits of corticosteroids in addition to optimized renin-angiotensin system blockers (RASBs), in those with lower estimated glomerular filtration rate (eGFR), or in different ethnic groups. Recent studies have attempted to address these issues. RECENT FINDINGS: Two observational studies suggest the efficacy of corticosteroids in those with lower eGFR, but with a higher risk of adverse events...
July 2017: Current Opinion in Nephrology and Hypertension
S Piracha, J Gnanapragasam, S M Tariq
Bronchoesophageal fistulae are a rare complication of tuberculosis. Traditionally they are managed by either thoracotomy with resection and closure of the fistulous tract or by taking a more conservative approach of giving standard treatment for tuberculosis while ensuring nutritional support through a nasogastric tube. We report a young student with disseminated tuberculosis complicated by a bronchoesophageal fistula. He was managed conservatively with anti-tuberculous chemotherapy and nutrition administered through a percutaneous endoscopic gastrostomy tube...
June 2016: Journal of the Royal College of Physicians of Edinburgh
Perrine Jullien, Christophe Mariat, Nicolas Maillard
No abstract text is available yet for this article.
December 2016: Néphrologie & Thérapeutique
Richard J Glassock
A Polar Views discussion by Pozzi and Rauen et al. on the interpretation and clinical application of the recently published Supportive Versus Immunosuppressive Therapy of Progressive IgA Nephropathy (STOP-IgAN) trial has elucidated important points concerning potential strengths and weaknesses of this landmark randomized trial. This critical examination of the impact of steroid monotherapy or steroid plus an immunosuppressive (IS) agent compared with 'supportive' therapy with inhibitors of the renin-angiotensin system (RAS) has enhanced our appreciation of the importance of rigorous application of titrated RAS inhibition in high-risk patients with persistent proteinuria >0...
November 2016: Nephrology, Dialysis, Transplantation
Claudio Pozzi
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest a 6-month course of corticosteroids (CS) for IgA nephropathy (IgAN) patients with persistent proteinuria ≥1 g/day despite 3-6 months of renin-angiotensin system (RAS) blockers and glomerular filtration rate (GFR) >50 mL/min/1.73 m(2) In December 2015, Rauen et al. (N Engl J Med 2015; 373: 2225-2236) published an article entitled 'Intensive supportive care plus immunosuppression in IgA nephropathy' (STOP-IgAN), which presented results from 379 IgAN patients from 32 nephrology centres in Germany...
November 2016: Nephrology, Dialysis, Transplantation
Thomas Rauen, Frank Eitner, Christina Fitzner, Jürgen Floege, Claudio Pozzi
A comprehensive supportive therapy approach constitutes the mainstay treatment of IgA nephropathy (IgAN) patients. In our recent Supportive versus immunosuppressive Therapy Of Progressive IgA Nephropathy (STOP-IgAN) trial, we systematically selected for patients at high risk of a progressive disease course and evaluated the effect of immunosuppression, combined with supportive care, on renal end points in these patients. There was a higher rate of full clinical remission and transient proteinuria reduction in immunosuppressed patients...
August 11, 2016: Nephrology, Dialysis, Transplantation
Terry King-Wing Ma, Stephen P McAdoo, Frederick Wai-Keung Tam
Spleen tyrosine kinase (Syk), a 72 kDa cytoplasmic non-receptor protein-tyrosine kinase, plays an important role in signal transduction in a variety of cell types. Ever since its discovery in the early 1990s, there has been accumulating evidence to suggest a pathogenic role of Syk in various allergic disorders, autoimmune diseases and malignancies. Additionally, there is emerging data from both pre-clinical and clinical studies that Syk is implicated in the pathogenesis of proliferative glomerulonephritis (GN), including anti-glomerular basement membrane disease, anti-neutrophil cytoplasmic antibody-associated GN, lupus nephritis and immunoglobulin A nephropathy (IgAN)...
2016: Nephron
Michio Fukuda, Osamu Hotta, Masashi Mizuno, Yoshiaki Ogiyama, Nobuyuki Ohte
Proportions of elderly aged ≥65 and ≥75 within Japan will increase to 30 and 20 %, respectively, in 2025, when "Baby-Boom Generations" will reach the age of 75 years. Okabayashi and colleagues report that even in elderly patients with IgA nephropathy (IgAN), immunosuppressive treatment can reduce proteinuria, with no adverse events. Their findings remind us of recent finding from STOP-IgAN study; additional immunosuppressive therapy to intensive supportive care [specifically renin-angiotensin system (RAS) inhibitors (RASi)] did not improve the outcome...
December 2016: Clinical and Experimental Nephrology
E Rutherford, P B Mark
No abstract text is available yet for this article.
March 2016: Journal of the Royal College of Physicians of Edinburgh
F Paolo Schena, Carlo Manno
No abstract text is available yet for this article.
March 10, 2016: New England Journal of Medicine
Isabelle Ayoub, Lee Hebert, Brad H Rovin
No abstract text is available yet for this article.
March 10, 2016: New England Journal of Medicine
Thomas Robert, Alexandra Cambier, Alexandre Hertig
No abstract text is available yet for this article.
March 10, 2016: New England Journal of Medicine
Jürgen Floege, Thomas Rauen, Frank Eitner
No abstract text is available yet for this article.
March 10, 2016: New England Journal of Medicine
Jürgen Floege
The present paper summarizes highlights in the field of glomerular diseases presented at the 2015 European Renal Association congress in London. Topics covered include a European survey on renal biopsy practice and indications, the STOP-IgAN randomized controlled trial in patients with IgA-nephropathy, B-cell- targeting therapies in minimal change nephropathy and focal segmental glomerulosclerosis (FSGS), novel insights into the action of glucocorticosteroids in glomerular crescent and scar (FSGS) formation, the immunoproteasome in IgA-nephropathy, socio-economic factors and glomerular disease progression, glomerular CD80 (B7-1) expression in FSGS patients and aldosterone-antagonism in proteinuric renal diseases...
February 2016: Nephrology, Dialysis, Transplantation
Ellen F Carney
No abstract text is available yet for this article.
February 2016: Nature Reviews. Nephrology
Thomas Rauen, Frank Eitner, Christina Fitzner, Claudia Sommerer, Martin Zeier, Britta Otte, Ulf Panzer, Harm Peters, Urs Benck, Peter R Mertens, Uwe Kuhlmann, Oliver Witzke, Oliver Gross, Volker Vielhauer, Johannes F E Mann, Ralf-Dieter Hilgers, Jürgen Floege
BACKGROUND: The outcomes of immunosuppressive therapy, when added to supportive care, in patients with IgA nephropathy are uncertain. METHODS: We conducted a multicenter, open-label, randomized, controlled trial with a two-group, parallel, group-sequential design. During a 6-month run-in phase, supportive care (in particular, blockade of the renin-angiotensin system) was adjusted on the basis of proteinuria. Patients who had persistent proteinuria with urinary protein excretion of at least 0...
December 3, 2015: New England Journal of Medicine
Jürgen Floege, John Feehally
Treatment options for primary IgA nephropathy (IgAN) and Henoch-Schönlein nephritis are still largely based on opinion or weak evidence. Consequently, the recent KDIGO Clinical Practice Guidelines for Glomerulonephritis have assigned low levels of evidence for almost all recommendations and suggestions related to these two diseases. In this Review, we describe an algorithm for structuring the treatment of IgAN depending on the clinical scenario. Key to therapeutic decision making is assessment of the individual's prognosis...
June 2013: Nature Reviews. Nephrology
Ryohei Yamamoto, Yasuyuki Nagasawa, Tatsuya Shoji, Hirotsugu Iwatani, Takayuki Hamano, Noritaka Kawada, Kazunori Inoue, Takuya Uehata, Tetsuya Kaneko, Noriyuki Okada, Toshiki Moriyama, Masaru Horio, Atsushi Yamauchi, Yoshiharu Tsubakihara, Enyu Imai, Hiromi Rakugi, Yoshitaka Isaka
BACKGROUND: Multiple community-based cohort studies of mainly middle-aged and elderly populations have shown that cigarette smoking is a risk factor for chronic kidney disease. However, little information is available about an effect of cigarette smoking on progression of primary kidney diseases, including immunoglobulin A (IgA) nephropathy. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 971 of 1,001 patients with a diagnosis of IgA nephropathy in 3 major nephrology centers in Osaka, Japan, between 1992 and 2005 who enrolled in the Study of Outcome and Practice Pattern of IgA Nephropathy (STOP-IgAN)...
August 2010: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Frank Eitner, Diana Ackermann, Ralf-Dieter Hilgers, Jürgen Floege
INTRODUCTION: The best treatment of IgA nephropathy (IgAN) is currently not well defined. The Supportive Versus Immunosuppressive Therapy of Progressive IgA Nephropathy (STOP IgAN) trial aims to answer if, in IgAN patients, an immunosuppressive treatment is more effective than a supportive treatment. METHODS: In a randomized prospective multicenter study (, NCT00554502), we will treat 148 patients at risk for progressive IgA nephropathy following a 6-month run-in phase, in 2 groups: (group a) supportive treatment: patients with a persistent proteinuria >0...
May 2008: Journal of Nephrology
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