Glomerular Disease Clinical Case Review

In this video, Craig Gordon, MD, nephrologist at Tufts Medical Center and associate professor of medicine at Tufts University School of Medicine, introduces a case of IgA nephropathy:

Editor’s note: The following is an automatically generated transcript of the above video.

"Hello, my name is Dr. Craig Gordon. I'm an associate professor of Medicine at Tufts University School of Medicine in the Division of Nephrology. And I'll be speaking today about an approach to the management of IgA nephropathy. IgA nephropathy as most people listening to this will realize is a very common condition compared with most of the other glomerular disorders. We see an estimate of incidence is 2.5 per 100,000 individuals. And it's estimated to have a median age of diagnosis of approximately 40 years of age. And importantly, data from our colleagues in the UK from their RaDaR, registry of rare kidney diseases, revealed that the median kidney survival time after the diagnosis is made is a little bit over 11 years. Taken together these three bullet points, really highlight consequence of IgA nephropathy as a major cause of kidney failure. It's a disease of young people with a shorter than we initially had assumed survival time. So, the age-old therapy has been ACE inhibitors and ARBs, good control of blood pressure, focus on dietary exercise, and other lifestyle changes.

And the question that exists now in 2024, is whether we can do better than this. And I think today's answer to that is a pretty strong and emphatic yes. There are so many new treatment options available these days that actually, the challenges shifted from finding a treatment to deciding which of the many newly-approved treatments are the ones we want to use in our patient. A lot of us are questioning should our focus be on hemodynamically-mediated treatments, like SGLT2 inhibitors or dual endothelial angiotensin receptor antagonists or DEARAs? Or instead, should our focus be on medications that impact the immune system in targeted immunosuppressive treatments? And these range from traditional corticosteroids with a systemic effect, time-released formulation of budesonide thought to have a more local effect or exciting advances in both complement blockade as well as other mechanisms I'll share a little bit later.

And so, the change in our discussion and our thought process is really now towards, which of these treatments should be used and perhaps should both hemodynamically-mediated treatments and immunosuppressive treatments be offered, and is there any way to select which patient to use which type of treatment? And we'll use a recent case to go through the conundrum we're all facing in 2024."