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Updates on the Treatment of Glomerulonephritis
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Updates on 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: closed (31 October 2024) | Viewed by 8900

Special Issue Editor

Dr. Lucio Manenti

E-Mail Website
Guest Editor
Chief Physician of the Nephrology and Dialysis Unit, Azienda Socio Sanitaria Ligure 5- La Spezia, Parma, Italy
Interests: clinical nephrology; clinical rheumatology; dialysis; hemodialysis; chronic renal failure; chronic kidney failure; renal; thrombotic microangiopathy; autoimmunity; kidney

Special Issue Information

Dear Colleagues,

Recently, new therapies have become available for glomerulonephritis. This is largely due to a better understanding of the pathogenetic mechanisms that determine the onset of each individual glomerulonephritis case and the mechanisms that determine the progression of renal damage in spite of the already known immunosuppressive therapies.

In particular, new drugs acting on B lymphocytes have already been incorporated into the guidelines for certain glomerulonephritis cases, and many more are to come with targets on different inflammatory pathways (such as the complement system) or different sites (such as the endothelium).

Moreover, non-immunosoppressive drugs that would slow down the progression of kidney damage particularly in certain glomerulonephritis have been added to the nephrologist “armamentarium”.

It is therefore of paramount importance to update the field of glomerulonephritis therapies in order to facilitate an increase in the personalisation of therapies in the light of the clinical and histopathological data available.

Dr. Lucio Manenti
Guest Editor

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Keywords

  • clinical nephrology
  • clinical rheumatology
  • chronic renal failure
  • chronic kidney failure
  • autoimmunity
  • complement system
  • kidney
  • treatment
  • glomerulonephritis
  • lupus nephritis
  • vasculitis
  • IgA nephropathy
  • membranous nephropathy
  • membranoproliferative glomerulonephritis

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Published Papers (5 papers)

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Research

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11 pages, 1334 KiB  
Article
Lung Ultrasound to Evaluate Fluid Status and Optimize Early Volume-Expansion Therapy in Children with Shiga Toxin-Producing Escherichia Coli–Haemolytic Uremic Syndrome: A Pilot Study
by Marco Allinovi, Ilaria Farella, Martina Giacalone, Gianmarco Lugli, Luigi Cirillo, Niccolò Parri and Francesca Becherucci
J. Clin. Med. 2024, 13(11), 3024; https://doi.org/10.3390/jcm13113024 - 21 May 2024
Viewed by 1331
Abstract
Background: Shiga toxin-producing Escherichia coli–haemolytic uremic syndrome (STEC-HUS) can result in kidney and neurological complications. Early volume-expansion therapy has been shown to improve outcomes, but caution is required to avoid fluid overload. Lung ultrasound scanning (LUS) can be used to detect fluid overload [...] Read more.
Background: Shiga toxin-producing Escherichia coli–haemolytic uremic syndrome (STEC-HUS) can result in kidney and neurological complications. Early volume-expansion therapy has been shown to improve outcomes, but caution is required to avoid fluid overload. Lung ultrasound scanning (LUS) can be used to detect fluid overload and may be useful in monitoring hydration therapy. Methods: This prospective observational pilot study involved children with STEC-HUS who were recruited from a regional paediatric nephrology centre. B-line quantification by LUS was used to assess fluid status at the emergency department (ED) admission and correlated with the decrease in patient weight from the target weight. A control group of children on chronic dialysis therapy with episodes of symptomatic fluid overload was also enrolled in order to establish a B-line threshold indicative of severe lung congestion. Another cohort of “healthy” children, without renal or lung-related diseases, and without clinical signs of fluid overload was also enrolled in order to establish a B-line threshold indicative of euvolemia. Results: LUS assessment was performed in 10 children with STEC-HUS at ED admission, showing an average of three B-lines (range 0–10). LUS was also performed in 53 euvolemic children admitted to the ED not showing kidney and lung disease (healthy controls), showing a median value of two B-lines (range 0–7), not significantly different from children with STEC-HUS at admission (p = 0.92). Children with STEC-HUS with neurological involvement during the acute phase and those requiring dialysis presented a significantly lower number of B-lines at admission compared to patients with a good clinical course (p < 0.001). Patients with long-term renal impairment also presented a lower number of B-lines at disease onset (p = 0.03). Conclusions: LUS is a useful technique for monitoring intravenous hydration therapy in paediatric patients with STEC-HUS. A low number of B-lines at ED admission (<5 B-lines) was associated with worse short-term and long-term outcomes. Further studies are needed to determine the efficacy and safety of an LUS-guided strategy for reducing complications in children with STEC-HUS. Full article
(This article belongs to the Special Issue Updates on the Treatment of Glomerulonephritis)
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9 pages, 235 KiB  
Article
Lupus Nephritis Outcomes after Stopping Immunosuppression
by Fahidah Alenzi, Oier Ateka-Barrutia, Chee Ken Cheah, Munther Khamashta, Shirish R. Sangle and David P. D’Cruz
J. Clin. Med. 2024, 13(8), 2211; https://doi.org/10.3390/jcm13082211 - 11 Apr 2024
Cited by 1 | Viewed by 1606
Abstract
Background/Objectives: Immunosuppression (IS) is a standard therapy for lupus nephritis (LN). Data on the outcomes of patients with LN after the discontinuation of immunosuppression remain uncertain. This study aimed to evaluate the outcomes and results of patients with lupus nephritis (LN) who ceased [...] Read more.
Background/Objectives: Immunosuppression (IS) is a standard therapy for lupus nephritis (LN). Data on the outcomes of patients with LN after the discontinuation of immunosuppression remain uncertain. This study aimed to evaluate the outcomes and results of patients with lupus nephritis (LN) who ceased immunosuppressive (IS) therapy. Methods: Records were obtained on the clinical and laboratory features of LN patients who were treated at our Lupus Unit. They included median values and ranges for various numerical variables such as patient age, disease duration, and treatment duration. Categorical variables such as gender, LN class, IS treatment type, and patient outcomes, which were categorized as either “stable” or “flare experienced”, were presented as percentages and frequencies. A flare in LN was characterized by a two-fold increase in serum creatinine levels and a rise in proteinuria following the cessation of IS medication. Results: Outcomes were assessed for 45 patients with LN who ceased IS therapy after achieving remission. The patients’ median age was 55 years (29–78). The median duration of treatment was 4 years (0.5–14). The LN histology distribution was class V = 24.4%, class IV = 17.8 %, class III = 17.8%, class III + IV = 15.6%, class III + V = 6.7%, class IV + V = 2.2%, and class II + IV and II = 2.2%. At the discontinuation of IS treatment, creatinine levels were elevated in 9/45 (20%) patients. Furthermore, 28.9% of patients relapsed after IS treatment discontinuation. Patients with anti-Smith antibodies (anti-Sm) were observed to have a higher occurrence of relapses, with six patients experiencing flare compared to four patients who remained stable (p = 0.03). Five (38.5%) of the patients with flares had high creatinine levels after IS discontinuation. Conclusions: Most of our patients maintained clinical remission and stable levels of LN parameters after IS treatment discontinuation. Those with a high serum creatinine level, ongoing proteinuria, depleted complement levels, and the presence of anti-Sm antibodies were more likely to experience flares after the discontinuation of IS therapy. Full article
(This article belongs to the Special Issue Updates on the Treatment of Glomerulonephritis)

Review

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17 pages, 780 KiB  
Review
Targeted Complement Treatments in Glomerulopathies: A Comprehensive Review
by Micaela Gentile and Lucio Manenti
J. Clin. Med. 2025, 14(3), 702; https://doi.org/10.3390/jcm14030702 - 22 Jan 2025
Cited by 1 | Viewed by 1381
Abstract
The complement system includes soluble and cell surface proteins and is an important arm of the innate immune system. Once activated, the complement system rapidly generates proteins with inflammatory and vasoactive activities. Although complement is crucial to host defense and homeostasis, its inappropriate [...] Read more.
The complement system includes soluble and cell surface proteins and is an important arm of the innate immune system. Once activated, the complement system rapidly generates proteins with inflammatory and vasoactive activities. Although complement is crucial to host defense and homeostasis, its inappropriate or uncontrolled activation can also drive tissue injury. Glomerulopathy encompasses a spectrum of diseases with diverse etiologies, clinical presentations, and outcomes. Among the intricate web of factors contributing to glomerulopathies pathogenesis, the role of complement activation has emerged as a focal point of research interest and therapeutic intervention. The pioneer drug was eculizumab, which made it possible to drastically change the prognosis of atypical hemolytic uremic syndrome, an otherwise fatal disease. This comprehensive review aims to elucidate the multifaceted interplay between complement pathways and glomerulopathies, shedding light on potential pathways for targeted therapies and improved patient care. Full article
(This article belongs to the Special Issue Updates on the Treatment of Glomerulonephritis)
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11 pages, 208 KiB  
Review
New Treatment Regimens, New Drugs, and New Treatment Goals for Lupus Nephritis
by Giovanni M. Rossi and Augusto Vaglio
J. Clin. Med. 2025, 14(2), 584; https://doi.org/10.3390/jcm14020584 - 17 Jan 2025
Viewed by 2710
Abstract
Lupus nephritis is one of the most severe manifestations of systemic lupus erythematosus, affecting roughly 40% of all lupus patients. With the introduction of cyclophosphamide and mycophenolate mofetil, outcomes have dramatically improved. However, 10% of patients still progress towards end-stage kidney disease, which [...] Read more.
Lupus nephritis is one of the most severe manifestations of systemic lupus erythematosus, affecting roughly 40% of all lupus patients. With the introduction of cyclophosphamide and mycophenolate mofetil, outcomes have dramatically improved. However, 10% of patients still progress towards end-stage kidney disease, which carries an elevated mortality rate. In recent years, several novel agents have been approved for use or have shown preliminary evidence of efficacy in lupus nephritis. These agents include belimumab, voclosporin, and obinutuzumab, among others. Efficacy has also been demonstrated in recent trials combining older drugs. However, determining which patients would benefit the most from novel agents or combined drug regimens and whether these drugs might serve as an alternative to current remission-induction drug regimens rather than as add-on therapies remain unresolved issues. In this review, we will explore the current evidence regarding the efficacy of novel agents. Full article
(This article belongs to the Special Issue Updates on the Treatment of Glomerulonephritis)
13 pages, 743 KiB  
Review
The Controversial Role of Glucocorticoids in Atheroembolic Renal Disease: A Narrative Review
by Maria Chiara Pacchiarini, Francesca Di Mario, Paolo Greco, Enrico Fiaccadori and Giovanni Maria Rossi
J. Clin. Med. 2024, 13(21), 6441; https://doi.org/10.3390/jcm13216441 - 27 Oct 2024
Viewed by 1237
Abstract
Cholesterol crystal embolism (CCE) is an underrecognized multisystemic disease caused by the displacement of cholesterol crystals from atheromatous aortic plaques to distal vascular beds, leading to ischemic injury of target organs, particularly the kidneys, i.e., atheroembolic renal disease (ARD). According to recent research, [...] Read more.
Cholesterol crystal embolism (CCE) is an underrecognized multisystemic disease caused by the displacement of cholesterol crystals from atheromatous aortic plaques to distal vascular beds, leading to ischemic injury of target organs, particularly the kidneys, i.e., atheroembolic renal disease (ARD). According to recent research, cellular necrosis, induced by crystal-induced cytotoxicity, enhances the autoinflammatory cascade of the NLPR3 inflammasome, leading in turn to the so-called “necroinflammation”. The purported involvement of the latter in CCE offers a rationale for the therapeutic approach with anti-inflammatory drugs such as glucocorticoids, the use of which has long been a matter of debate in CCE. Diagnostic delay and no consistent evidence regarding efficacious treatment, leading to inconsistency in clinical practice, may worsen the already poor prognosis of ARD. The possible role of glucocorticoids in the treatment of ARD is thereby herein explored in a narrative fashion, analyzing the limited data from case reports and clinical trials. Full article
(This article belongs to the Special Issue Updates on the Treatment of Glomerulonephritis)
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