Recent Treatment Advances and New Trials in Adult Nephrotic Syndrome

Abstract

The etiology of nephrotic syndrome is complex and ranges from primary glomerulonephritis to secondary forms. Patients with nephrotic syndrome often need immunosuppressive treatment with its side effects and may progress to end stage renal disease. This review focuses on recent advances in the treatment of primary causes of nephrotic syndrome (idiopathic membranous nephropathy (iMN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS)) since the publication of the KDIGO guidelines in 2012. Current treatment recommendations are mostly based on randomized controlled trials (RCTs) in children, small RCTs, or case series in adults. Recently, only a few new RCTs have been published, such as the Gemritux trial evaluating rituximab treatment versus supportive antiproteinuric and antihypertensive therapy in iMN. Many RCTs are ongoing for iMN, MCD, and FSGS that will provide further information on the effectiveness of different treatment options for the causative disease. In addition to reviewing recent clinical studies, we provide insight into potential new targets for the treatment of nephrotic syndrome from recent basic science publications.

Ofatumumab in post‐transplantation recurrence of focal segmental glomerulosclerosis in a child

“…Similarly, the literature on ofatumumab for treatment of post‐transplant FSGS is scarce. Thus far, only pediatric case reports are available on this subject . In the pediatric nephrology community, it has been used in patients with nephrotic syndrome refractory to plasmapheresis and other immunosuppressive agents (ie, tacrolimus, CsA, and rituximab) …”

“…Thus far, only pediatric case reports are available on this subject. 19 In the pediatric nephrology community, it has been used in patients with nephrotic syndrome refractory to plasmapheresis and other immunosuppressive agents (ie, tacrolimus, CsA, and rituximab). 7,11,12,20 Although our patient, with a genetic mutation of unknown significance, had improvement with established treatments for recurrence of FSGS, his proteinuria remained in nephrotic range.…”

Alicerces e Adversidades das Ciências da Saúde no Brasil 2

“…Conforme GIL (2007) Pesquisa documental equipara-se à pesquisa bibliográfica, porém o que difere as mesmas é a essência da sua origem. A pesquisa bibliográfica utiliza documentos já analisados, enquanto na pesquisa documental os materiais não possuem tratamento analítico.…”

“…As glomerulopatias apresentam-se por um conjunto de sintomas chamado síndrome nefrótica (SN), que se caracteriza, principalmente, por proteinúria, edema, hipoproteinemia e dislipidemia (Veronese et al, 2010;Königshausen;Sellin, 2017).…”

Chinese Herbal Injections for Primary Nephrotic Syndrome in Adults: A Systematic Review and Network Meta‐Analysis

“…Renin-angiotensin system (RAS) blockade and/or immunosuppressive agents are recommended treatments. However, patients show varying responses; 20%-50% of patients continue with substantial proteinuria, which is associated with higher risk of end stage kidney disease (ESKD) [2][3][4]. Additionally, failure of clinical remission is associated with increased risk of various complications, such as infections and thromboembolisms.…”