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      Friday, March 31, 2023
      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
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      CME / ABIM MOC

      Are You Up to Date on Pathogenesis and Treatment of Immunoglobulin A Nephropathy?

      • Authors: Kirk Campbell, MD
      • CME / ABIM MOC Released: 3/16/2023
      • Valid for credit through: 3/16/2024
      Start Activity

      • Credits Available

        Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

        ABIM Diplomates - maximum of 0.25 ABIM MOC points

        You Are Eligible For

        • Letter of Completion
        • ABIM MOC points

      Target Audience and Goal Statement

      This activity is intended for nephrologists, primary care physicians, and pediatricians who manage patients with IgAN.

      The goal of this activity is for learners to be better able to understand the role of proteinuria and endothelin in IgAN and current and emerging treatment options.

      Upon completion of this activity, participants will:

      • Have increased knowledge regarding the
        • Role of proteinuria and endothelin in IgAN
      • Self-assess learning needs related to
        • Management of IgAN in clinical practice

      Disclosures

      Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

      All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

      Faculty

      • Kirk Campbell, MD

        Professor of Medicine
        Icahn School of Medicine at Mount Sinai
        New York, New York

         

        Disclosures

        Kirk Campbell, MD, has the following relevant financial relationships:
        Consultant or advisor for: Calliditas; Chinook Therapeutics; Covidien (formerly Tyco Healthcare/Mallinckrodt); Travere; Vertex Pharmaceuticals Incorporated
        Research funding from: Aurinia
        Contracted researcher for: Calliditas; Omeros Corporation; Vera Therapeutics

      Editors

      • Jennifer Hakkarainen, PA-C

        Medical Education Director, Medscape, LLC

        Disclosures

        Jennifer Hakkarainen, BS, PA-C, has no relevant financial relationships.

      • Gina Montanero, PharmD

        Associate Medical Writer, Medscape, LLC

        Disclosures

        Gina Montanero, PharmD, has no relevant financial relationships.

      Compliance Reviewer

      • Stephanie Corder, ND, RN, CHCP

        Associate Director, Accreditation and Compliance, Medscape, LLC

        Disclosures

        Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

      Peer Reviewer

      This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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      In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

        For Physicians

      • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

        Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

        Contact This Provider

      For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

      Instructions for Participation and Credit

      There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

      This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

      Follow these steps to earn CME/CE credit*:

      1. Read about the target audience, learning objectives, and author disclosures.
      2. Study the educational content online or print it out.
      3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

      You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

      *The credit that you receive is based on your user profile.

      From Medscape Education Nephrology
      CME / ABIM MOC

      Are You Up to Date on Pathogenesis and Treatment of Immunoglobulin A Nephropathy?

      Authors: Kirk Campbell, MDFaculty and Disclosures

      CME / ABIM MOC Released: 3/16/2023

      Valid for credit through: 3/16/2024

      processing....

      References

      1. Coppo R, et al. Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. Kidney Int. 2014;86:828-836.
      2. 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.
      3. Magistroni R, et al. New developments in the genetics, pathogenesis, and therapy of IgA nephropathy. Kidney Int. 2015;88:974-989.
      4. Selvaskandan H, et al. Monitoring immune responses in IgA nephropathy: biomarkers to guide management. Front Immunol. 2020;11:572754.
      5. Komers R, et al. Dual inhibition of renin-angiotensin-aldosterone system and endothelin-1 in treatment of chronic kidney disease. Am J Physiol Regul Integr Comp Physiol. 2016;310:R877-R884.
      6. Maillard N, et al. Current understanding of the role of complement in IgA nephropathy. J Am Soc Nephrol. 2015;26:1503-1512.
      7. Rizk DV, et al. The emerging role of complement proteins as a target for therapy of IgA nephropathy. Front Immunol. 2019;10:504.
      8. Trimarchi H, et al. IgA nephropathy: "State of the art": a report from the 15th International Symposium on IgA Nephropathy celebrating the 50th anniversary of its first description. Kidney Int. 2019;95:750-756.
      9. Fakhouri F, et al. Practical management of C3 glomerulopathy and Ig-mediated MPGN: facts and uncertainties. Kidney Int. 2020;98:1135-1148.
      10. Rodrigues JC, et al. IgA nephropathy. Clin J Am Soc Nephrol. 2017;12:677-686.
      11. Sevillano AM, et al. Remission of hematuria improves renal survival in IgA nephropathy. J Am Soc Nephrol. 2017;28:3089-3099.
      12. Yu GZ, et al. Persistent hematuria and kidney disease progression in IgA nephropathy: a cohort study. Am J Kidney Dis. 2020;76:90-99.
      13. 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:S1-S276.
      14. Tortajada A, et al. The role of complement in IgA nephropathy. Mol Immunol. 2019;114:123-132.
      15. Berthoux F, et al. Predicting the risk for dialysis or death in IgA nephropathy. J Am Soc Nephrol. 2011;22:752-761.
      16. Cattran DC, et al. The impact of sex in primary glomerulonephritis. Nephrol Dial Transplant. 2008;23:2247-2253.
      17. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. Takeaways for clinicians from the KDIGO2021 clinical practice guideline for the management of IGA nephropathy. 2021. Accessed July 6, 2022. https://kdigo.org/wp-content/uploads/2017/02/KDIGO-GD-Guideline-Key-Takeaways-for-Clinicians-IgAN.pdf
      18. Trimarchi H, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017;91:1014-1021.
      19. Haas M, et al. A multicenter study of the predictive value of crescents in IgA nephropathy. Correction in: J Am Soc Nephrol. 2017;28:1665. J Am Soc Nephrol. 2017;28:691-701.
      20. UK Kidney Association (UKKA). The International IgA NEPHROPATHY Prediction Tool. Accessed January 10, 2022. https://ukkidney.org/resource/international-iga-nephropathy-prediction-tool
      21. Barbour SJ, et al; International IgA Nephropathy Network. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med. 2019;179:942-952.
      22. Floege J. A new tool to predict the risk of progression in IgA nephropathy. Kidney Int. 2019;96:808-809.
      23. Rehnberg J, et al. Inflammatory bowel disease is more common in patients with IgA nephropathy and predicts progression of ESKD: a Swedish population-based cohort study. J Am Soc Nephrol. 2021;32:411-423.
      24. Budesonide [prescribing information]. Approved 1997. Revised December 2021.
      25. Lv J, et al. Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA. 2022;327:1888-1898.
      26. Barratt J, et al; NefIgArd Trial Investigators. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int. 2022. doi:10.1016/j.kint.2022.09.017 [Epub ahead of print].
      27. Cheung CK, et al. An Update on the current state of management and clinical trials for IgA nephropathy. J Clin Med. 2021;10:2493.
      28. Fellström BC, et al. Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial. Lancet. 2017;389:2117-2127.
      29. ClinicalTrials.gov. Efficacy and safety of Nefecon in patients with primary IgA (immunoglobulin A) nephropathy (Nefigard). Accessed December 6, 2022. https://clinicaltrials.gov/ct2/show/NCT03643965
      30. Trachtman H, et al; DUET Study Group. DUET: a phase 2 study evaluating the efficacy and safety of sparsentan in patients with FSGS. J Am Soc Nephrol. 2018;29:2745-2754.
      31. Heerspink HJL, et al. Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial. Lancet. 2019;393:1937-1947.
      32. Raina R, et al. The role of endothelin and endothelin antagonists in chronic kidney disease. Kidney Dis. 2020;6:22-34.
      33. Eculizumab [prescribing information]. Approved 2007. Revised November 2020.
      34. Willows J, et al. The role of complement in kidney disease. Clin Med (Lond). 2020;20:156-160.
      35. McNamara LA, et al. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morb Mortal Wkly Rep. 2017;66:734-737.
      36. Goodship THJ, et al. Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference. Kidney Int. 2017;91:539-551.
      37. Barratt J, et al. POS-546 Efficacy and safety of iptacopan in IgA nephropathy: results of a randomized double-blind placebo-controlled phase 2 study at 6 months. Kidney Int Rep. 2022;7:S236.
      38. Bruchfeld A, et al. C5a receptor inhibitor avacopan in immunoglobulin A nephropathy - an open-label pilot study. Clin Kidney J. 2022;15:922-928.
      39. Lafayette RA, et al. Safety, Tolerability and efficacy of narsoplimab, a novel MASP-2 inhibitor for the treatment of IgA nephropathy. Kidney Int Rep. 2020;5:2032-2041.
      40. ClinicalTrials.gov. Study of the safety and efficacy of OMS721 in patients with immunoglobulin A (IgA) nephropathy. Accessed December 6, 2022. https://clinicaltrials.gov/ct2/show/NCT03608033?term=NCT03608033&draw=2&rank=1
      41. ClinicalTrials.gov. Study of efficacy and safety of LNP023 in primary IgA nephropathy patients (APPLAUSE-IgAN). Accessed December 6, 2022. https://clinicaltrials.gov/ct2/show/NCT04578834?term=NCT04578834&draw=2&rank=1
      42. Wheeler DC, et al; DAPA-CKD Trial Committees and Investigators. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy. Kidney Int. 2021;100:215-224.
      43. Staplin N, et al. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet. 2022;400:1788-1801.
      44. ClinicalTrials.gov. Atrasentan in patients with proteinuric glomerular diseases (AFFINITY). Accessed December 7, 2022. https://clinicaltrials.gov/ct2/show/NCT04573920
      45. Tesar V, et al. SUN-037 No impact of newly initiated immunosuppressive therapy observed on long-term antiproteinuric effect of sparsentan in focal segmental glomerulosclerosis: interim 84-week analysis of the duet trial. Kidney Int Rep. 2019;4:S168-S169.
      46. ClinicalTrials.gov. Study of sparsentan in patients with primary focal segmental glomerulosclerosis (FSGS) (DUPLEX). Accessed December 6, 2022. https://clinicaltrials.gov/ct2/show/NCT03493685
      47. ClinicalTrials.gov. A study of the effect and safety of sparsentan in the treatment of patients with IgA nephropathy (PROTECT). Accessed December 7, 2022. https://clinicaltrials.gov/ct2/show/NCT03762850
      48. ClinicalTrials.gov. Atrasentan in patients with IgA nephropathy (ALIGN). Accessed December 7, 2022. https://clinicaltrials.gov/ct2/show/NCT04573478
      « Return to: Are You Up to Date on Pathogenesis and Treatment of Immunoglobulin A Nephropathy?
      CME / ABIM MOC Information
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