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Glomerular disease in 2023

Reaping the rewards of mechanistic discovery in glomerular disease

Nature Reviews Nephrology volume 20, pages 77–78 (2024)Cite this article

Subjects

Several successfully completed clinical trials of novel therapies in glomerular disease were reported in 2023. Building on important mechanistic discoveries about disease onset and progression over the past several years, these therapies raise hope that multiple options will be available to reduce the risk of kidney failure in glomerular disease.

Key advances

  • A large cohort study of UK patients with IgA nephropathy (IgAN) demonstrated that lifetime risk of kidney failure is high, even among patients with low levels of proteinuria.

  • The 2-year results of the placebo-controlled phase III trial of targeted-release formulation of budesonide (NefIgArd trial) demonstrated a reduction in estimated glomerular filtration rate (eGFR) decline in patients with IgAN, building on earlier results that showed a reduction in proteinuria after 9 months of treatment.

  • The 2-year results of the active-controlled phase III trial of sparsentan, a dual endothelin and angiotensin II subtype 1 receptor antagonist, led to improvement in proteinuria and chronic eGFR decline compared with irbesartan.

  • In a phase IIa trial, inaxaplin (a small molecule inhibitor of apolipoprotein 1 channel function) provided initial evidence of reduced proteinuria over 13 weeks in patients with focal segmental glomerulosclerosis.

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Fig. 1: Paths to therapeutic innovation in glomerular disease.

References

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Author information

Authors and Affiliations

  1. Division of Nephrology, University of Michigan, Ann Arbor, MI, USA

    Arpita Joshi & Laura H. Mariani

Authors
  1. Arpita Joshi
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  2. Laura H. Mariani
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Corresponding author

Correspondence to Laura H. Mariani.

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Competing interests

L.H.M. has consulting agreements with several pharmaceutical companies, including Travere therapeutics and Calliditas Therapeutics and Chinook Therapeutics, and has received grant funding from Boehringer-Ingelheim and Reliant Glycoscienes; their employer, the University of Michigan, is an enrolling site for the Vertex clinical trial. A.J. declares no competing interests.

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Joshi, A., Mariani, L.H. Reaping the rewards of mechanistic discovery in glomerular disease. Nat Rev Nephrol 20, 77–78 (2024). https://doi.org/10.1038/s41581-023-00804-y

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