Fine Mapping Implicates a #Deletion of CFHR1 and CFHR3 in Protection from IgA #Nephropathy in Han Chinese

http://m.jasn.asnjournals.org/content/27/10/3187.abstract

These data indicate that dysregulated activity of the alternative complement pathway contributes to IgAN pathogenesis in both Asians and Europeans and implicate CFHR3,1Δ as the functional allele at this locus.

Prophylactic #hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced #nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30057-0/abstract

Contrast-induced nephropathy was recorded in eight (2·6%) of 307 non-hydrated patients and in eight (2·7%) of 296 hydrated patients. The absolute difference (no hydration vs hydration) was −0·10% (one-sided 95% CI −2·25 to 2·06; one-tailed p=0·4710). No hydration was cost-saving relative to hydration. No haemodialysis or related deaths occurred within 35 days. 18 (5·5%) of 328 patients had complications associated with intravenous hydration.

Interpretation
We found no prophylaxis to be non-inferior and cost-saving in preventing contrast-induced nephropathy compared with intravenous hydration according to current clinical practice guidelines.

Effect of Oral #Methylprednisolone on Clinical Outcomes in Patients With #IgA #Nephropathy
The TESTING Randomized Clinical Trial
http://jamanetwork.com/journals/jama/article-abstract/2646717

Guidelines recommend corticosteroids in patients with IgA nephropathy and persistent proteinuria, but the effects remain uncertain.

After randomization of 262 participants (mean age, 38.6 SD, 11.1 years; 96 37% women; eGFR, 59.4 mL/min/1.73 m2; urine protein excretion, 2.40 g/d) and 2.1 years’ median follow-up, recruitment was discontinued because of excess serious adverse events. Serious events occurred in 20 participants (14.7%) in the methylprednisolone group vs 4 (3.2%) in the placebo group (P = .001; risk difference, 11.5% 95% CI, 4.8%-18.2%), mostly due to excess serious infections (11 8.1% vs 0; risk difference, 8.1% 95% CI, 3.5%-13.9%; P < .001), including 2 deaths. The primary renal outcome occurred in 8 participants (5.9%) in the methylprednisolone group vs 20 (15.9%) in the placebo group (hazard ratio, 0.37 95% CI, 0.17-0.85; risk difference, 10.0% 95% CI, 2.5%-17.9%; P = .02).

Conclusions and Relevance Among patients with IgA nephropathy and proteinuria of 1 g/d or greater, oral methylprednisolone was associated with an increased risk of serious adverse events, primarily infections. Although the results were consistent with potential renal benefit, definitive conclusions about treatment benefit cannot be made, owing to early termination of the trial.

!!
#Canagliflozin and Renal Outcomes in Type 2 #Diabetes and #Nephropathy

https://www.nejm.org/doi/full/10.1056/NEJMoa1811744

The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture.

CONCLUSIONS
In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years.