The highlights of nephrology in 2024

Abstract

The year 2024 marks significant progress in nephrology, particularly in immunoglobulin A (IgA) nephropathy and nephroprotection. In IgA nephropathy, new molecules such as sibeprenlimab and atacicept, targeting the BAFF and APRIL pathways, have shown a reduction in proteinuria and stabilization of glomerular filtration rate (GFR), confirming the importance of these pathways in the disease. Furthermore, the involvement of the microbiota in the pathology opens up promising therapeutic prospects. In nephroprotection, the combination of SGLT2 inhibitors, endothelin receptors and GLP1 agonists enhances the management of chronic kidney disease, including diabetic nephropathy, with positive effects on proteinuria and renal survival. The discovery of anti-nephrin antibodies in idiopathic nephrotic syndrome (INS) marks a major step forward, enabling better prediction of the response to immunosuppressants and a more refined diagnosis between autoimmune and genetic pathologies, and opening up the future prospect of more personalized management of this pathology. Derived from hematology, anti-CD38 therapies are also showing promising results in glomerulopathies, while CAR-T cells are opening the way to new therapeutic options for refractory autoimmune diseases such as lupus. These advances testify to a move towards precision medicine in nephrology, where the personalization of treatments could, in time, significantly improve the management of patients with kidney pathologies.