Novelties in the Treatment of Glomerulonephritis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 20 October 2025 | Viewed by 2142

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Dear Colleagues,

As you well know, primary and secondary glomerulonephritis are related to systemic autoimmune diseases, infections, drugs, or neoplasia and affect a significant percentage of patients of all ages, including children and young adults, where it is the most common cause of end-stage kidney disease. In the past, the therapeutic approach was mostly based on steroids, including boli, eventually alternated each month with alkilants for 6 months or on cyclosporine, depending on the type of glomerulonephritis. Over the last few years, several advancements have been made on the pathogenesis, diagnosis, and treatment of these diseases. In this regard, important steps were made, including the demonstration that primary membranous nephropathy is an autoimmune disease and the increasing recognition of the important pathogenetic role of the complement and of the B cells, leading to the development and use of drugs aiming at this target. It is our pleasure to invite you to contribute to this Special Issue.

Prof. Dr. Francesco Locatelli
Guest Editor

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Keywords

  • glomerulonephritis
  • primary and secondary
  • IGA nephritis
  • membranous nephropathy
  • minimal change nephropathy
  • glomerulosclerosis
  • C3 glomerulonephritis
  • vasculitis systemic steroids
  • budesonide
  • alkilants
  • cyclosporine
  • complement
  • rituximab
  • SGLT2
  • sparsentan

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Published Papers (2 papers)

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Review

17 pages, 1325 KiB  
Review
The Recurrence of Systemic Diseases in Kidney Transplantation
by Gabriella Moroni, Marta Calatroni and Claudio Ponticelli
J. Clin. Med. 2025, 14(8), 2592; https://doi.org/10.3390/jcm14082592 - 9 Apr 2025
Viewed by 519
Abstract
Kidney transplantation is the most effective replacement therapy for kidney failure, providing the best outcomes in terms of patient survival and offering a better quality of life. However, despite the progressive improvement in kidney survival, the recurrence of original disease remains one of [...] Read more.
Kidney transplantation is the most effective replacement therapy for kidney failure, providing the best outcomes in terms of patient survival and offering a better quality of life. However, despite the progressive improvement in kidney survival, the recurrence of original disease remains one of the most important causes of graft loss and a major challenge that requires clinical vigilance throughout the transplant’s duration. Additionally, the type and severity of recurrence affect both treatment options and graft survival. This is especially true for the recurrence of systemic diseases. In this narrative review, we will discuss the timing, frequency, severity, and treatment of post-transplant recurrence in three systemic diseases: lupus nephritis (LN), Antineutrophil Cytoplasmic Antibodies (ANCA)-associated glomerulonephritis (ANCA-GN), and Henoch–Schönlein purpura (HSP). The recurrence of lupus nephritis is less common than that of primary focal segmental glomerulosclerosis or C3 glomerulopathy. Its severity can range from mild mesangial to diffuse proliferative forms, with varying prognoses and treatment options, much like the original disease. In some patients with LN, as well as in those with ANCA-GN or HSP, the reactivation of the primary disease can affect other organs besides the kidneys, potentially leading to life-threatening conditions. These cases may require a multidisciplinary approach, making these transplants clinically more challenging. Extrarenal flare-ups often necessitate an increase in immunosuppression, which in turn raises the risk of infections. In these autoimmune diseases, the role of immunological tests in determining the timing of kidney transplants remains a topic of ongoing debate. However, elevated levels of certain immunological markers, such as anti-dsDNA antibodies, ANCA titers, or serum immunoglobulin A may indicate a reactivation of the disease, suggesting the need for more intensive patient monitoring. Full article
(This article belongs to the Special Issue Novelties in the Treatment of Glomerulonephritis)
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19 pages, 905 KiB  
Review
Membranous Nephropathy
by Claudio Ponticelli
J. Clin. Med. 2025, 14(3), 761; https://doi.org/10.3390/jcm14030761 - 24 Jan 2025
Viewed by 1207
Abstract
Membranous nephropathy is a glomerular disease that may be caused by exogenous risk factors in genetically predisposed individuals (primary MN) or may be associated with other autoimmune diseases, drug exposure, or cytotoxic agents (secondary MN). Primary membranous nephropathy (PMN) is an autoimmune disease [...] Read more.
Membranous nephropathy is a glomerular disease that may be caused by exogenous risk factors in genetically predisposed individuals (primary MN) or may be associated with other autoimmune diseases, drug exposure, or cytotoxic agents (secondary MN). Primary membranous nephropathy (PMN) is an autoimmune disease in which antigens—mainly the phospholipase A2 receptor—are located in the podocytes and are targeted by circulating antibodies, leading to in situ formation of immune complexes that activate the complement system. Clinically, the disease is characterized by nephrotic syndrome (NS) and associated complications. The outcome of PMN can vary, but untreated patients with NS may progress to end-stage kidney disease (ESKD) in 35–40% of cases within 10 years. Treatment primarily aims to prevent NS complications and progression to ESKD. The most commonly used immunosuppressive drugs are rituximab, corticosteroids, cyclophosphamide, and calcineurin inhibitors. Most patients may experience an improvement of proteinuria, which can sometimes be followed by NS relapse. Fewer than 50% of patients with PMN achieve complete and stable remission. In addition to immunosuppressive therapy, antiproteinuric, anti-lipemic, and anticoagulant medicaments are often required. Full article
(This article belongs to the Special Issue Novelties in the Treatment of Glomerulonephritis)
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