Nephrology Knowledge into Practice Podcast

In 2021, a work group of international experts published an update to the 2012 iteration of this guideline. To do so they reviewed the latest evidence through a systematic literature review, with the aim of providing a useful resource for clinicians caring for individuals with glomerular disease through actionable recommendations. In this episode we speak to Dr Richard Glassock, member of the work group, to hear his insights on the key takeaways from the guideline, and what has changed in this iteration. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. Reference: KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S1–S276.  Disclosures: Dr Richard Glassock declares the following: Stock Ownership - Reata Pharmaceuticals Speakers Bureau - Aurinia Advisory Board - Alexion, Bio-Cryst, Novartis, Otsuka, RenaSight, Travere, Vertex Consultant - Alexion, Arrowhead, Aurinia, Bio-Cryst, Calliditas, Chinook, Equillium, Horizon Pharma, Ionis, Midornid, Nephro-Sys, Omeros, River3Renal, Therini Bio, Travere, Vera Pharmaceuticals Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships within 24 months (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any ineligible companies. All relevant financial relationships have been mitigated prior to this activity. The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors. This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. Discussion of Off-Label, Investigational or Experimental Drug Use: Corticosteroids are mentioned in the context of the treatment of FSGS. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

In 2021, a work group of international experts published an update to the 2012 iteration of this guideline. To do so they reviewed the latest evidence through a systematic literature review, with the aim of providing a useful resource for clinicians caring for individuals with glomerular disease through actionable recommendations.  In this episode we speak to Professor Jürgen Floege, co-chair of the work group, to hear his insights on the key takeaways, and the clinical data that has emerged since the guideline update was made.   By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources.   References available here Disclosures:   Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.  The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships within 24 months (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any ineligible companies. All relevant financial relationships have been mitigated prior to this activity.  The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.   This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.   Discussion of Off-Label, Investigational or Experimental Drug Use: Corticosteroids are mentioned in the context of the treatment of IgA nephropathy and reducing kidney function decline or failure.  Funding:   This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education. 

Current standard of care for IgA nephropathy (IgAN) involves optimized supportive care, antihypertensives, and dietary and lifestyle modifications. Despite these interventions, ~30% of patients progress to end stage renal disease. Recent approvals of delayed-release budesonide for IgAN and dapagliflozin for chronic kidney disease, and further investigational agents have the potential to alter the treatment landscape for IgAN. In this episode, Professor Rosanna Coppo offers her expert insight into the potential clinical implications of current and investigational therapies, both now and in the future. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: References available here This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education. Disclosures: Prof. Rosanna Coppo has no disclosures to declare. Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships within 24 months (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any ineligible companies. All relevant financial relationships have been mitigated prior to this activity. The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors. This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. Discussion of Off-Label, Investigational or Experimental Drug Use: Atrasentan, C5 inhibitor RNA therapies, eculizumab, empagliflozin, iptacopan, narsoplimab, ravulizumab, and sparsentan are mentioned in the context of the treatment of IgA nephropathy and reducing kidney function decline or failure. Sparsentan is also discussed in the context of the treatment of focal segmental glomerulosclerosis. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

Historically, treatment options for focal segmental glomerulosclerosis (FSGS) have been limited to high-dose corticosteroids or calcineurin inhibitors in those ineligible or intolerant to steroids. However, an increase in clinical trial activity in the field of kidney disease may carry hope for novel therapeutic options for FSGS. This is illustrated by the recent approval of dapagliflozin for chronic kidney disease. In this episode, Dr. Kirk Campbell offers his expert opinion into the potential clinical implications of current and investigational therapies, both now and in the future. Learning objective After listening to this podcast series, learners will be able to recall the potential clinical implications of current and investigational therapies for FSGS. References available here Disclosures Dr. Kirk Campbell declares the following financial relationships from the past 24 months: Consultant - ANI, Calliditas, Chinook, Travere Research/grant support - Vertex Liberum IME staff, ACHL staff, and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors. This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labelling. Physicians should consult the current manufacturers’ prescribing information for these products. ACHL requires its speakers to disclose that a product is not labelled for the use under discussion. Funding: This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Eli Lilly has had no influence on the content of this education.

IgA nephropathy presents with a clinically diverse set of symptoms of wide-ranging severity and a varied disease course. As our understanding of IgA nephropathy has improved, various tools have been developed to help assess risk of progression to kidney failure. This episode offers insight into the use of freely available tools that can assist with the management of IgA nephropathy. We are joined by Dr Andrew Bomback to discuss how these tools are applied in the clinic. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. Penfold RS, et al. Primary IgA nephropathy: current challenges and future prospects. Int J Nephrol Renovasc Dis. 2018;11:137-148. 2. Rodrigues JC, et al. IgA nephropathy. Clin J Am Soc Nephrol. 2017;12(4): 677-686. 3. Trimarchi H et al. Oxford classification of IgA nephropathy 2016: An update from IgA nephropathy classification working groups. Kidney Int 2017;91(5):1014–1021. 4. Barbour S et al. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med 2019;179(7):942-952. 5. International IgAN Prediction Tool at Biopsy. Available at: https://qxmd.com/calculate/calculator_499/international-igan-prediction-tool. Accessed May 2022. 6. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1–S276. 7. Thompson A et al. Proteinuria reduction as a surrogate end point in trials of IgA nephropathy. Clin J Am Soc Nephrol 2019;14:469–481. Disclosures: Dr Andrew Bomback declares the following: Consultant: Travere Therapeutics, Calliditas Therapeutics Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

While FSGS was once thought to be a single disease entity, it is now understood to be a pattern of injury caused by diverse mechanisms, but classifying FSGS accurately can be challenging. In this episode, we provide an overview of these classifications and risk factors that can help stratify disease progression risk and assist with determining management approaches. To help understand how we can most effectively and accurately classify FSGS, we are joined by Professor An De Vriese, who is head of the Division of Nephrology and Infectious Disease at the AZ Sint-Jan hospital in Bruges, Belgium. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. De Vriese AS et al. Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach. J Am Soc Nephrol 2018;29(3):759-774. 2. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S1–S276. 3. Jacobs-Cachá C et al. Challenges in primary focal segmental glomerulosclerosis diagnosis: from the diagnostic algorithm to novel biomarkers. Clin Kidney J 2020;14(2):482-491. 4. Friedman DJ & Pollak MR. APOL1 nephropathy: From genetics to clinical applications. CJASN, 2021;16(2):294-303. 5. Zee J et al. APOL1 genotype-associated morphologic changes among patients with focal segmental glomerulosclerosis. Pediatric Nephrology. 2021;36(9):2747-2757. 6. Shabaka A et al. Focal segmental glomerulosclerosis: State-of-the-art and clinical perspective. Nephron 2020;144(9):413-427. Disclosures: Prof. An De Vriese has no disclosures to announce. Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

While focal segmental glomerulosclerosis (FSGS) is rare overall, it is one of the most common glomerular diseases on Europe, North America and Latin America. Rather than being a specific disease entity, it is a pattern of injury that takes various forms that, together with the clinical presentation, have important implications for treatment and prognosis. Join Dr Sanjeev Sethi, pathologist at the Mayo Clinic, Rochester, Minnesota, USA, for an overview of our current understanding of how FSGS develops and presents. By completing this module you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources.  References: 1. McGrogan A, Franssen CF, de Vries CS: The incidence of primary glomerulonephritis worldwide: A systematic review of the literature. Nephrol Dial Transplant 26: 414–430, 2011  2. Sim JJ, Batech M, Hever A, Harrison TN, Avelar T, Kanter MH, Jacobsen SJ. Distribution of Biopsy-Proven Presumed Primary Glomerulonephropathies in 2000-2011 Among a Racially and Ethnically Diverse US Population. Am J Kidney Dis. 2016 Oct;68(4):533-544.  3. Rosenberg AZ, Koop JB. Focal segmental glomerulosclerosis. Clin J Am SOc Nephrol. 2017;12(3): 502-517.   4. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1–S276.   5. Lepori N, Zand L, Sethi S, Fernandez-Juarez G, Fervenza F. Clinical and pathological phenotype of genetic casues of focal segmental glomerulosclerosis in adults. Clinical Kidney J. 2018;11 (2): 179-190.  Disclosures:  Dr Sanjeev Sethi has no relevant disclosures to report at this time. Funding:  This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME and validated by an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

IgA nephropathy (IgAN) is a leading cause of chronic kidney disease and the most common glomerular disease worldwide. But its pathogenesis has not yet been fully elucidated, leaving some questions so far unanswered. Join Dr Richard Lafayette for an overview of our current understanding of how this disease develops and presents. By completing this module you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. Penfold RS, Prendecki M, McAdoo S, Tam FW. Primary IgA nephropathy: current challenges and future prospects. Int J Nephrol Renovasc Dis. 2018 Apr 12;11:137-148. 2. Rodrigues JC, Haas M, Reich HN. IgA nephropathy. Clin J Am Soc Nephrol. 2017;12(4): 677-686. doi: 10.2215/CJN.07420716 3. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1–S276. 4. Chang S, Li X-K. The role of immune modulation in pathogenesis of IGA nephropathy. Front Med.7:92. Disclosures: Dr Richard Lafayette declares the following: Research: Travere, Omeros, Calliditas, Vera, Otsuka/Visterra Consulting: Travere, Omeros, Calliditas, Vera, Otsuka/Visterra All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME and validated by an independent steering committee; Travere Therapeutics has had no influence on the content of this education.