Glomerular Diseases: Updates on Pathogenesis and Treatment

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Glomerular basement membrane "spikes" in a patient with membranous glomerulonephritis.
Glomerular basement membrane "spikes" in a patient with membranous glomerulonephritis.

Editor's note: The article is a preview of a course being offered on April 2 during the National Kidney Foundation's 2013 Spring Clinical Meetings in Orlando, Fla.

A number of new diagnostic and therapeutic tools have emerged in the field of glomerular diseases. Practicing nephrologists will benefit from hearing an update regarding the utility of these tools in the diagnosis and management of patients with glomerular diseases.

Participants in the course will review current research in pathophysiology, examine novel diagnostic tools, and identify current therapeutic options in specific glomerular diseases. The course includes lectures, question-and-answer sessions, case-based discussions, and panel sessions to review course material.

Presentations will start with a review of minimal change disease Jai Radhakrishnan, MD, of Columbia University Medical Center in New York, who will discuss its presentation in adults, and the treatment of frequently relapsing or steroid-dependent minimal change disease. Stuart Shankland, MD, of the University of Washington in Seattle, will then review focal segmental glomerulosclerosis (FSGS), various therapies, and the role of permeability factors in recurrent FSGS. 

Michael Choi, MD, of the Johns Hopkins University School of Medicine in Baltimore, will discuss kidney and viral infections, highlighting hepatitis B, C and HIV-related glomerular diseases. Fernando C. Fervenza, MD, of the Mayo Clinic in Rochester, Minn., will follow with an examination of various aspects of membranous nephropathy, including the utility of anti PLA-2R antibody titers in pathogenesis, diagnosis and treatment, as well as new therapies for this disease. 

In his presentation, Richard Glassock, MD, of the David Geffen School of Medicine at the University of California Los Angeles, will emphasize a new classification scheme for membranoproliferative glomerulonephritis (MPGN)—which has been proposed by Dr. Fervenza and Sanjeev Sethi, MD, PhD, of Mayo Clinic in Rochester, Minn. The scheme is based on immunoflourescence rather than electron microscopy findings, and which highlights the role of complement dysregulation in subclassifications of this disease.

Next, Paul Sanders, MD, of Kirklin Clinic Nephrology in Birmingham, Ala., will review monoclonal gammopathy associated glomerular diseases such as AL amyloidosis and others, with discussion of serum free light chains for diagnosis and therapies for these various diseases. Dr.  Glassock will return to review anti-GBM disease, a new topic added this year. Dr.  Fervenza will also be back to give an update on ANCA- associated vasculitis and will discuss standard and newer therapies for varied clinical presentations.

Following this talk, James Balow, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Md., will review the pathology of lupus nephritis and examine standard and novel therapies. Gerald Appel, MD, of Columbia University Medical Center in New York, will follow by answering questions regarding pathogenesis of IgA nephropathy and the role of multiple immunosuppressive versus other supportive treatment options in this disease.

Agnes Fogo, MD, of Vanderbilt University Medical Center in Nashville, Tenn., will review hereditary nephropathies, focusing on Alports syndrome, thin basement membrane disease and Fabrys disease. Finally, Susan Quaggin, MD, of Northwestern University in Chicago, will review the complex area of thrombotic microangiopathies and will emphasize new insights into pathogenesis. 

Interactions with faculty will include faculty presentations of illustrative cases to the audience during the meeting. Roles will then be reversed with the faculty panel answering questions from the audience on course material or discussion of patients. The course should be of special interest to nephrologists that deal with complex patients with glomerular diseases or are looking for an update in the subject. It will be a wonderful opportunity for the audience to learn from, and interact with the outstanding faculty assembled for this pre-course.

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