Glomerular diseases最新文献

{"title":"Case Series of the Combination of Voclosporin and Belimumab Treatment of Lupus Nephritis.","authors":"Homa Timlin, Abbal Koirala, Duvuru Geetha","doi":"10.1159/000552239","DOIUrl":"10.1159/000552239","url":null,"abstract":"<p><strong>Introduction: </strong>Lupus nephritis (LN) remains challenging with high treatment failure and relapse rates. Current therapies often fail to achieve sustained renal remission. The objective of this research was to assess the safety and clinical effectiveness of dual therapy using voclosporin and belimumab in individuals with LN confirmed via kidney biopsy.</p><p><strong>Methods: </strong>Retrospective case series of 16 female patients (median age 36) with kidney biopsy-proven LN treated with voclosporin (15.8-23.7 mg BID) plus belimumab (200 mg SC weekly/IV) between 2012 and 2025 in routine clinical practice. Baseline was defined as the laboratory value closest to the first kidney biopsy. Longitudinal data for urine protein-to-creatinine ratio (UPCR), serum creatinine, C3/C4 complement, and anti-dsDNA antibodies were analyzed using the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Initiation of voclosporin and belimumab was associated with a marked reduction in proteinuria, with median UPCR declining from 2.175 g/g to 0.082 g/g and remaining low at final follow-up (0.131 g/g; all <i>p</i> ≤ 0.0005). Serologic markers improved concurrently, with increases in complement levels (C3 65.0-109.5, C4 6.5-20.5) and a decline in median anti-dsDNA (51.5-12.0). 62.5% of patients tapered corticosteroids to ≤5 mg/day or discontinued them, while serum creatinine increased modestly from 0.77 to 0.89 mg/dL.</p><p><strong>Conclusions: </strong>The combination of voclosporin and belimumab is highly effective in inducing rapid and sustained renal remission and facilitating a significant reduction in corticosteroid dose in patients with LN.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"208-215"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcome Assessment Endpoints in Nephrotic Syndrome Drug Development: Research Partner Feedback on Patient-Centered Trial Design.","authors":"John Devin Peipert, Maja Kuharic, Noelle E Carlozzi, Courtney N Hurt, Ashley E Rahimi, Jin-Shei Lai, Trivellore Raghunathan, Somayeh Hashemi, Howard Trachtman, Louise Oni, Rebecca Scherr, Yan Zhai, Eloise Salmon","doi":"10.1159/000550524","DOIUrl":"10.1159/000550524","url":null,"abstract":"<p><strong>Introduction: </strong>Nephrotic syndrome (NS) clinical trials often rely on biomarkers or clinical measures as primary endpoints, but these may not fully capture the treatment benefits that matter most to patients. Edema-related swelling, a central manifestation of NS, profoundly affects patients' health-related quality of life, including physical function, severe physical and mental symptoms, and ability to participate in routine activities, highlighting the need for clinical outcome assessments (COAs) that directly measure its severity and impact. The PREPARing a clinical outcomes assessment set for Nephrotic Syndrome (Prepare-NS) project, supported by the United States Food and Drug Administration's Center for Drug Evaluation and Research Pilot Grant Program, aims to address this unmet need.</p><p><strong>Methods: </strong>We conducted qualitative interviews with and surveyed clinical trialists from industry, academia, and patient advocacy organizations. Each queried participants on how COAs, including patient- and observer-reported outcomes, could be used to demonstrate treatment benefit in trials. Participants were asked about preferences for timing, frequency, and format of COA assessment, as well as how COA-based endpoints could best capture swelling impacts, and how these might relate to other trial endpoints.</p><p><strong>Results: </strong>Participants expressed strong support for COA-based endpoints to complement clinical or biomarker endpoints, noting that the impact of disease as represented by proteinuria does not fully capture potential treatment benefit to patients. We identified multiple endpoints to operationalize swelling COAs in clinical trials. Additional key considerations included optimal timing of assessments, feasibility of daily diaries (i.e., daily symptom ratings), potential confounding factors, and alignment of COAs with proteinuria or other endpoints.</p><p><strong>Conclusions: </strong>Collectively, these insights inform the Prepare-NS initiative's ongoing development and validation efforts. Incorporating standardized COAs in NS clinical trials could expand efficacy endpoints and pave the way for patient-centered NS drug development.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"103-112"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Remission as a Function of Exposure to Cyclophosphamide in Patients with Primary Membranous Nephropathy: A One-Year Cohort Study.","authors":"Swati Arora, Jorge E Rojas-Rivera, Madeline S Chung, Himanshu Patel, Rajshree Patil, Hitesh Bhatia, Luba R Muaddi, Omar Osman, Brad Rovin, Isabelle Ayoub","doi":"10.1159/000551814","DOIUrl":"10.1159/000551814","url":null,"abstract":"<p><strong>Introduction: </strong>Primary membranous nephropathy (pMN) is a leading cause of nephrotic syndrome (NS) in adults. Cyclophosphamide (CYC) with glucocorticoids (GCs) is recommended for high and very high-risk patients, but the optimal treatment duration and cumulative dose remain unclear. This study aimed to compare the effectiveness and safety of short-duration (SD) versus long-duration (LD) oral CYC regimens in pMN patients with NS.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study of 54 adult patients with biopsy-proven pMN treated with oral CYC in the USA and India between 2010 and 2022. Patients received either SD-CYC (≤3 months) or LD-CYC (>3 months). The primary outcome was overall remission (complete or partial) at 12 months. Secondary outcomes included complete remission (CR) rates and adverse events. Analyses were stratified by treatment duration and cumulative CYC dose.</p><p><strong>Results: </strong>Overall remission at 12 months was similar between SD and LD groups (73% vs. 83%, <i>p</i> = 0.088), with a trend toward higher CR in the LD group (47% vs. 23%, <i>p</i> = 0.077). The SD group had more baseline chronic kidney changes, which may have impacted outcomes. By cumulative dose, patients receiving >3 g CYC had significantly higher overall remission and CR after adjustment for baseline characteristics and cumulative GC dose. Serious adverse events occurred in 18.5% of patients, with no significant differences between groups.</p><p><strong>Conclusion: </strong>Short-term oral CYC combined with GC may be a safe alternative to LD-CYC regimens for achieving clinical remission in pMN. Although these findings align with recent evidence supporting the efficacy of low-dose CYC in pMN, well-designed clinical trials are still needed for more robust clinical validation.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"184-193"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nudging Nephrologists in Cardiovascular Risk Assessment and Management in Glomerular Diseases Treated with Immunosuppressants: An Implementation Study.","authors":"Jovan Sao Ang Sim, Felicia Loo, Lydia Lim, Sing Yi Chia, Regina Lek, Hui Zhuan Tan, Irene Yanjia Mok, Tung Lin Lee, Jason C J Choo, Chieh Suai Tan, Cynthia Lim","doi":"10.1159/000551591","DOIUrl":"10.1159/000551591","url":null,"abstract":"<p><strong>Introduction: </strong>Glomerulonephritis and its treatment may be associated with cardiometabolic disease, so optimizing glycaemic and lipid control is important to mitigate cardiovascular risk. We aimed to evaluate the impact of an electronic medical record (EMR)-based physician prompt on glycaemic and lipid management among older adults with glomerulonephritis receiving immunosuppressive therapy.</p><p><strong>Methods: </strong>This was a single-centre implementation study with a pre-post-design. We included adults ≥40 years old with active glomerulonephritis treated with immunosuppressants who received the physician prompt between July 2022 and June 2024. Data at 6-monthly intervals were obtained from the EMR. We compared the prevalence of glycaemic and lipid evaluation during follow-up visits before and after the intervention using mixed-effects logistic regression models.</p><p><strong>Results: </strong>A total of 192 patients (median age 58 [interquartile range: 48, 69] years) with 859 visits were included: 474 visits prior to the intervention and 385 visits after its implementation. The most frequent causes of glomerulonephritis were lupus nephritis (26.9%), IgA nephropathy (20.4%), and ANCA-associated vasculitis (15.7%). Glycaemic evaluation was performed at 51.7% and 69.6% of follow-up visits before and after intervention, respectively. Glycaemic evaluation was significantly more likely at post- compared with pre-intervention visits (OR = 2.42 [95% CI: 1.73, 3.36]) after accounting for patients and physicians as random effects, and after adjusting for age, sex, kidney function, follow-up clinic type and duration, and RAS blocker and statin therapy: OR = 2.38 (95% CI: 1.69, 3.38). Fasting lipid was performed at 43.7% and 42.9% of follow-up visits before and after intervention, respectively, and was not different pre- and post-intervention.</p><p><strong>Conclusion: </strong>A physician-directed nudge significantly increased glycaemic evaluation but not lipid evaluation in older patients with glomerulonephritis treated with immunosuppressants.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"194-207"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Phospholipase A2 Receptor Antibody Is Associated with Thrombogenesis in Primary Membranous Nephropathy: A Systematic Review and Meta-Analysis.","authors":"Paula Dibo, Henrique Alexsander Ferreira Neves, Raghunandan Konda, Alanis Yael Szyferman, Federico Napoli, Ifunanya Peculiar Nnajiofor, Clara Campoverde, Saeed Razaq, Arun Rajasekaran","doi":"10.1159/000551008","DOIUrl":"10.1159/000551008","url":null,"abstract":"<p><strong>Introduction: </strong>Primary membranous nephropathy (PMN) is a leading cause of nephrotic syndrome in adults and is associated with an increased risk of thromboembolic events. The anti-serum phospholipase A2 receptor antibody (anti-PLA2R Ab) is highly specific for PMN, correlates with immunological disease activity, and evidence suggests that it may contribute to a prothrombotic state. This systematic review and meta-analysis aimed to further explore the potential association between serum anti-PLA2R Ab and thromboembolic events in patients with PMN and investigate whether they may serve as a possible biomarker for thrombogenesis.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane databases were systematically searched for studies that investigated the presence of anti-PLA2R Ab as a potential risk factor for thrombogenesis in patients with PMN. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were pooled across studies. Heterogeneity was evaluated using I² statistics.</p><p><strong>Results: </strong>We included seven studies involving 1,162 patients; mean age was 53 years. Patients with anti-PLA2R Ab had significantly higher odds of thromboembolism compared to those without anti-PLA2R Ab (OR 1.52; 95% CI 1.10, 2.09; <i>p</i> = 0.01). Patients diagnosed with thromboembolism exhibited significantly lower serum albumin levels compared to those without thromboembolism (<i>p</i> = 0.003), but there were no statistical differences in proteinuria (<i>p</i> = 0.18) or age (<i>p</i> = 0.90) between patients with and without thromboembolism. Proteinuria (<i>p</i> = 0.59), serum creatinine (<i>p</i> = 0.77), or estimated glomerular filtration rate (<i>p</i> = 0.59) did not differ between anti-PLA2R Ab-positive and negative patients. However, total cholesterol levels were higher in patients with positive anti-PLA2R Ab (<i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>There was a significant association between the presence of anti-PLA2R Ab and the risk of thromboembolism in patients with PMN, supporting their potential use as a biomarker for thrombogenesis in this population.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"113-124"},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits: An Immunologic Crossroads.","authors":"Eric Magliulo, Yaman Alali, Lihong Bu, Tanya Wildes, Prasanth Ravipati","doi":"10.1159/000551513","DOIUrl":"10.1159/000551513","url":null,"abstract":"<p><strong>Background: </strong>Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is largely regarded as a form of monoclonal gammopathy of renal significance; however, 70-80% of cases lack evidence of an associated monoclonal lymphoproliferative disorder. Emerging evidence suggests it is a shared clinicopathologic manifestation of multiple, distinct disease etiologies including infection, autoimmunity, complement dysregulation, and neoplasia. Development of a more precise, etiology-based system of classification is hindered by limitations in adequately characterizing the clonal nature of monotypic deposits in renal tissue. Furthermore, the current body of evidence evaluating effective treatment options for PGNMID is limited by retrospective data, small sample sizes, and variability in treatment regimens. As a result, treatment strategies are largely extrapolated from established therapies used in overt hematologic malignancies.</p><p><strong>Summary: </strong>In this review, we discuss the classification, pathogenesis, clinicopathologic features, diagnostic challenges, and treatment approach for PGNMID.</p><p><strong>Key message: </strong>The heterogenous nature and lack of consensus to guide the management of PGNMID highlights the need for an individualized and multidisciplinary team approach involving nephrologists, hematologists, and nephropathologists. Practicing clinicians need to be aware of the limitations of diagnostic tools used in routine clinical practice.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"125-138"},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contactin-1-Associated Membranous Nephropathy after Multiple mRNA 1273 COVID-19 Vaccinations: A Case Report.","authors":"Jonathan E Zuckerman, Anthony Sisk, Elliot Parham Copen, Stephen Copen","doi":"10.1159/000551432","DOIUrl":"10.1159/000551432","url":null,"abstract":"<p><p>Contactin-1-associated membranous nephropathy is a rare type of membranous nephropathy typically seen in the setting of chronic inflammatory demyelinating polyneuropathy. Here we present a case of a 79-year-old man who presented with ankle edema and was found to have 2,888 milligrams of proteinuria per 24 h and membranous nephropathy on kidney biopsy. Staining for multiple membranous antigens including phospholipase A-2 receptor, NELL-1, and EXT-2 were negative. Liquid chromatography tandem mass spectrometry was performed on glomeruli and identified contactin-1 as the target antigen. Classic secondary causes of membranous nephropathy were excluded including systemic autoimmune disease, malignancies, and medications. Interestingly, the membranous nephropathy occurred 1 month after receiving the last of five doses of mRNA COVID 1273 that occurred over a 19-month period. The patient subsequently underwent spontaneous remission without initiation of disease targeted therapy, suggesting a tentative association between the COVID-19 vaccination and the membranous nephropathy. Additionally, this patient did not have any significant neuropathies typically seen with contactin-1-associated membranous nephropathy. To our knowledge, this is the first case report demonstrating a temporal association between contactin-1-associated membranous nephropathy and vaccination against COVID-19 with mRNA 1273. Our findings in this case broaden the clinical spectrum of the rare contactin-1-associated membranous nephropathy.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"178-183"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter 2 Inhibitors in Lupus Nephritis and ANCA-Associated Vasculitis: Unmet Needs to be Addressed.","authors":"Gisele Vajgel, Marcus D Säemann, Andreas Kronbichler","doi":"10.1159/000551255","DOIUrl":"10.1159/000551255","url":null,"abstract":"<p><strong>Background: </strong>Current treatment of severe autoimmune glomerulonephritis such as lupus nephritis (LN) and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) relies primarily on immunosuppression to reduce kidney inflammation and chronic damage. However, many patients exhibit persistent proteinuria despite treatment, which serves as a prognostic biomarker for long-term outcomes. The residual proteinuria after 12 months might reflect hyperfiltration in remaining nephrons due to chronic damage rather than active inflammation, contributing to progressive kidney function deterioration.</p><p><strong>Summary: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are established drugs used to minimize chronic kidney disease (CKD) progression, demonstrating benefits beyond glycemic control. These medications reduce intraglomerular pressure, decrease albuminuria, minimize tubular workload, and exhibit anti-inflammatory properties through various mechanisms which ultimately reduce hard cardiovascular and kidney-related endpoints in large clinical trials. However, their potential role in managing LN and AAV remains unexplored because such individuals were systematically excluded from the landmark clinical trials due to concerns about immunosuppression and infection risks.</p><p><strong>Key messages: </strong>In this review, we describe the mechanisms underlying SGLT2i effectiveness, explore the rationale and existing evidence gaps regarding their application and optimal timing for SGLT2i initiation in LN and AAV patients; and advocating for inclusion of these individuals in future clinical trials. Addressing these gaps could significantly improve long-term outcomes in these vulnerable populations.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"139-156"},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediabetes in Children and Adults with Glomerular Disease.","authors":"William Rasmussen, Kayla Sifre, Nathaniel Putnam, Ashley E Rahimi, Eloise C Salmon, Elaine S Kamil, Sharon G Adler, Richard A Lafayette, Susan F Massengill, Yujie Wang, Zubin J Modi","doi":"10.1159/000551266","DOIUrl":"10.1159/000551266","url":null,"abstract":"<p><strong>Introduction: </strong>Glomerular disease (GD) and diabetic nephropathy are both leading causes of end-stage kidney disease (ESKD) in the USA. Much is known about each individually, but less of any interactions between the two. There is emerging evidence that factors specific to GD, such as immunosuppression, may increase the risk of diabetes, which in turn could compound glomerular filtration rate decline through the mechanisms of diabetic nephropathy. Understanding the epidemiology of prediabetes and diabetes in GD patients may inform improved screening and prevention practices in this population and may lead to strategies that mitigate progression to ESKD. The aim of this study was to delineate risk factors for prediabetes in GD.</p><p><strong>Methods: </strong>Data were extracted from University of Michigan and Kidney Research Network electronic health record registry with patients classified by age at GD at diagnosis or first nephrology appointment (child [age <18 y, <i>n</i> = 406] and adult [≥18 y, <i>n</i> = 339]). A Cox proportional hazards model was calculated using prediabetes after kidney disease onset as the outcome, adjusted for age, sex, race, weight, hypertension, and defined relevant drug prescriptions. A subgroup analysis was performed to track the progression from prediabetes to diabetes.</p><p><strong>Results: </strong>A total of 148 patients (19.9% of cohort) developed prediabetes in study follow-up. Adult GD patients were more likely than pediatric GD patients to progress (HR: 1.73 [95% CI: 1.19-2.50]), as were patients with uncontrolled hypertension (HR: 9.61 [95% CI: 3.02-30.61]) and controlled hypertension (HR: 6.50 [95% CI: 1.91-22.18]). The use of beta-blockers, statins, or diuretics was also associated with higher prediabetes risk (HR: 2.87 [95% CI: 1.98-4.17]).</p><p><strong>Conclusion: </strong>Adult age, worsening control of hypertension, and certain medications were associated with increased prediabetes risk in preexisting GD. More data, in particular prospective data, are needed to refine risk relationships and incidence data.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"94-102"},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Refractory Immune Complex-Mediated Membranoproliferative Glomerulonephritis with Pegcetacoplan: A Case Report.","authors":"Abdullah Al-Muhaiteeb, Anas Al Yousef, Ahmad Altaleb","doi":"10.1159/000551111","DOIUrl":"10.1159/000551111","url":null,"abstract":"<p><p>Immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) lacks proven targeted therapy and is often refractory to nonspecific immunosuppression. Dysregulation of the alternative complement pathway provides a mechanistic rationale for proximal C3 inhibition. This article presents our experience with the management of a case of refractory IC-MPGN with the C3 inhibitor, pegcetacoplan. A 19-year-old man presented with nephrotic-range proteinuria, haematuria, hypoalbuminaemia (20 g/L), and depressed complement (C3 0.06-0.14 g/L with normal C4). Kidney biopsy demonstrated IC-MPGN with granular IgA/IgG/C3 along capillary loops and electron-dense deposits in subendothelial, intramembranous, and subepithelial locations. Despite treatment with corticosteroids and tacrolimus, disease activity persisted, prompting initiation of pegcetacoplan 1,080 mg subcutaneously twice weekly. The urine protein-creatinine ratio (UPCR) decreased to 751 mg/g (-70% from baseline), and 24-h urinary protein excretion declined to 1,386 mg/day (-83%). Serum albumin increased from 20 to 36 g/L, while serum creatinine remained stable (92 µmol/L). Complement levels normalised, with C3 rising from 0.06 g/L to 1.27 g/L, permitting discontinuation of antihypertensive and immunosuppressive medications. No adverse events were observed. This case supports C3-targeted therapy with pegcetacoplan to achieve rapid biochemical and clinical remission in refractory IC-MPGN. Longer follow-up with histologic correlation and biomarker-guided selection is needed to define durability and responders.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"6 1","pages":"84-93"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}