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IgA nephropathy associated with superimposed acute kidney injury. A report of an unusual case
(Sociedad Latinoamericana de Nefrología e Hipertensión, 2026) Restrepo, Carlos M.; Villavicencio Ceron, Vanessa; daza arnedo, rodrigo andres; Rico-Fontalvo, Jorge; De Rosa, Marcelo; Remache-Otanez, Verónica P.
IgA nephropathy is the most common glomerulopathy, characterized by immune complex deposits in the glomeruli causing renal damage. It is associated with genetic predisposition and abnormal immune responses. We present the case of a 15-year-old adolescent with glomerular hematuria and acute renal deterioration following a viral illness and exposure toNSAIDs and iodinated contrast. Renal biopsy revealed IgA nephropathy and acute tubulointerstitial nephritis (ATIN) witheosinophilia. She received methylprednisolone pulses, achieving renal recovery. This case highlights the importance of distinguishing acute complications in patients with IgA nephropathy to ensure timely and appropriate management. IgA nephropathy and interstitial nephritis are connected through inflammatory mechanisms in the kidney. Although IgA nephropathyprimarily affects the glomeruli with different histologic patterns, in this case we found interstitial inflammation exacerbatingdamage and accelerating the deterioration of renal function. This highlights the importance of addressing all the mechanismof acute kidney injury to prevent progression to end-stage renal disease.
Secukinumab in active lupus nephritis: results from a phase III randomized, placebo-controlled study (SELUNE) and an open-label extension study
(Oxford University Press, 2026) Hui Zhao, Ming; Cons Molina, Fidencio; Aroca, Gustavo; Tektonidou, Maria G.; Mathur, Anubhav; Tangadpalli, Radhika; Sun, Rui; Martin, Ruvie; Pellet, Pascale; Phuong Huynh, Thao Ngoc
LN occurs in 50% of patients with SLE and is associated with significant morbidity and mortality [1]. The current management of LN is based on disease severity and includes CSs, anti-malarial agents, and CS-sparing immunosuppressive agents. Despite the availability of new therapeutic options, the trials and observational studies have shown a complete renal response (CRR) of <50%, and the long-term effects of these therapeutic options are not yet known [2]. Therefore, LN management remains challenging. Without effective control of disease activity, patients may develop end-stage kidney disease (ESKD) and ultimately need renal replacement therapy [1, 3]. The evidence suggests that 6% to 19% of patients with LN develop ESKD over 10 years [3–5]. Recently, the Lupus Midwest Network (LUMEN) registry revealed that the survival rate for LN was 70%, and that 13% of patients with LN developed ESKD at 10 years [4]. Therefore, even with the current treatments, the risk of kidney failure remains high, highlighting the unmet treatment need in LN. In addition, factors such as limited access to specialized lupus centres and poor treatment adherence significantly impact outcomes in LN. These barriers contribute to delayed diagnosis and suboptimal disease control, underscoring the need for holistic management strategies [6]. The pathophysiology of LN is complex and is characterized by autoantibody production and inflammatory cell infiltration into renal tissues. IL-17–producing Th type 17 (Th17) cells exhibit significant hyperactivation, leading to inflammation, which has been implicated in LN-associated kidney damage [7, 8]. Moreover, IL-17 stimulates inflammatory cytokine production by renal cells, leading to granulopoiesis as well as changes in renal function [9]. Thus, IL-17 may contribute to disease progression, and its inhibition may lead to clinical improvement in LN [10]. Secukinumab, an anti–IL-17A antibody, has shown efficacy with a consistent and favourable safety profile in psoriasis, PsA, axial SpA, and hidradenitis suppurativa [11, 12]. Previous case reports have suggested improvement in LN with secukinumab [13, 14]. A patient with refractory LN achieved a CRR within 8 months of secukinumab treatment [13]. A phase III core study (SELUNE) and an extension study were conducted to evaluate the efficacy and safety of s.c. secukinumab 300 mg compared with placebo, in combination with the standard of care (SoC) for patients with active LN. Both studies were terminated early due to futile results following a planned futility analysis of the core study. The final results of the two studies are reported herein.
Iptacopan in IgA Nephropathy — Final 24-Month Data
(Massachusetts Medical Society, 2026) Barratt, Jonathan; Eren, Necmi; Kashihara, Naoki; Maes, Bart; Rizk, Dana V.; Rovin, Brad; Trimarchi, Hernán; Zhang, Hong; Wang, Weiming; Kocyigit, Ismail; Hao, Chuanming; Tesař, Vladimir; Turgutalp, Kenan; Yang, Li; Xing, Guangqun; Duro Garcia, Valter; Hyeok Han, Seung; Lu, Wanhong; Pisani, Antonio; Weinmann-Menke, Julia; Eitner, Frank; Guerard, Nicolas; Butylin, Dmytro; Monaco, Luca; Scosyrev, Emil; Magirr, Annabel; Renfurm, Ronny; Hach, Thomas; Perkovic, Vlado; the APPLAUSE-IgAN Study Group; Aroca-Martinez, Gustavo; Zuluaga, Gustavo
Background Overactivation of the alternative complement pathway contributes to IgA nephropathy and glomerular inflammation. In the 9-month interim analysis of this phase 3 trial, iptacopan, a complement factor B inhibitor, led to a significant reduction of 38.3% in the 24-hour urinary protein-to-creatinine ratio as compared with placebo and had an acceptable safety profile. Methods In this phase 3 trial, we enrolled adults who had IgA nephropathy, an estimated glomerular filtration rate (eGFR) of at least 30 ml per minute per 1.73 m2 of body-surface area, and a 24-hour urinary protein-to-creatinine ratio of 1 or higher (with protein and creatinine both measured in grams) despite supportive care. Patients were randomly assigned, in a 1:1 ratio, to receive oral iptacopan (200 mg) or placebo twice daily. The primary end point for the final analysis was the annualized total eGFR slope as estimated over a 24-month period. Secondary end points included a composite kidney-failure end point (i.e., a sustained decline in eGFR of ≥30%, a sustained eGFR of <15 ml per minute per 1.73 m2, the initiation of maintenance dialysis, receipt of kidney transplant, or death from kidney failure), assessed in a time-to-event analysis. Safety was also assessed. Results Among 477 patients included in the final analysis, 238 had been randomly assigned to iptacopan and 239 to placebo. The annualized total eGFR slope was −3.10 ml per minute per 1.73 m2 per year with iptacopan, as compared with −6.12 ml per minute per 1.73 m2 per year with placebo (difference, 3.02 ml per minute per 1.73 m2 per year; 95% confidence interval [CI], 2.02 to 4.01; adjusted P<0.001). A composite kidney-failure end-point event occurred in 21.4% of the patients in the iptacopan group, as compared with 33.5% of those in the placebo group (hazard ratio, 0.57; 95% CI, 0.40 to 0.81; adjusted P=0.003). The incidence of adverse events was 87.0% in the iptacopan group and 89.1% in the placebo group. Serious adverse events occurred in 12.2% of the patients who received iptacopan and in 11.7% of those who received placebo, and serious infections in 6.7% and 2.1%, respectively. No deaths occurred.
WCN24-1762 Urgent cardiovascular cases in patients diagnosed with diabetes and de novo in a healthcare provider in magangué (BOL) between january 2021 and july 2023
(International Society of Nephrology ISN, 2026) González-Torres, Henry Joseth; Baleta Plata, Waldys Alberto; Hernández Nieto, Bryan ; Agamez Díaz, Adriana Isabel; Domínguez-Vargas, Alex; Peña Vargas , William arturo; Aroca-Martinez, Gustavo
The relationship between diabetes and cardiovascular risk has been extensively studied; the mortality associated with these two conditions remains a clinical and public health concern. The objetive was to assess cardiovascular emergencies in patients with pre-existing and newly diagnosed diabetes at a healthcare facility in Magangué, Bolívar, between January 2021 and July 2023.
WCN24-1676 Results of a kidney transplant program at an clinic in the colombian caribbean region – 2019 to 2022
(International Society of Nephrology ISN, 2026) González-Torres, Henry Joseth; Moran Marin, Leinad Yamile; Aroca-Martinez, Gustavo; Agamez Díaz, Adriana Isabel; Dominguez Vargas, Alex Alfredo; Cabarcas Barbosa, Omar de Jesus; Hernandez Agudelo, Sandra
Kidney transplantation is an effective treatment option and, in many cases, the best option for patients with end-stage renal disease. However, it still faces significant challenges that need to be addressed to improve the quality of life and survival of transplant recipients. Therefore, follow-up programs for these renal patients are essential. Hence, the objective of this study was to evaluate the outcomes of a kidney transplant program in a clinic in the Colombian Caribbean Region between the years 2019 and 2022.
WCN24-1355 Risk of dialysis according to the Kidney Failure Risk Equation (KFRE) in patients with chronic kidney disease enrolled in a nephroprotection program in la Guajira (Colombia) between 2021 and 2023
(International Society of Nephrology ISN, 2026) González-Torres, Henry Joseth; Chacon Buendía, Ernesto Alfonso; Aroca-Martinez, Gustavo; Agamez Díaz, Adriana Isabel; Dominguez Vargas, Alex Alfredo; Cadena Bonfanti, Andrés Ángelo
Chronic Kidney Disease (CKD) is a progressive, long-term condition characterized by a gradual and irreversible deterioration of renal function. In its early stages, it is a slow and silent process, leading to a decrease in the estimated glomerular filtration rate (eGFR), a measure of kidney function. Therefore, the objective was to monitor the risk profiles for requiring renal replacement therapy according to the Kidney Failure Risk Equation (KFRE) in patients with Chronic Kidney Disease enrolled in a nephroprotection program in La Guajira (CO) between the years 2021 and 2023.
WCN24-1370 Incidence of acute kidney injury and the need for renal support therapy in the postoperative period of cardiovascular surgery
(International Society of Nephrology ISN, 2026) González-Torres, Henry Joseth; Ospina Herrera, Daniel; Aroca-Martinez, Gustavo; Agamez Díaz, Adriana Isabel; Aguilera Caro, Sofia; Dominguez Vargas, Alex Alfredo
Major surgery is the second leading cause of Acute Kidney Injury (AKI), with cardiovascular surgery having the highest incidence. This is due to technical conditions like aortic clamping and extracorporeal circulation, which lead to systemic reactions including embolism formation, low cardiac output, prolonged hypotension, and contact-activated systemic inflammation. This study aimed to evaluate the incidence of AKI and the need for renal support therapy after cardiovascular surgery.
WCN26-3469 Binutuzumab induces histologic remission and deep kidney parenchymal b-cell depletion in patients with lupus nephritis: exploratory analyses from the regency trial
(International Society of Nephrology ISN, 2026) Rovin, Brad H.; Martins, Elsa; Austin, Cary D.; Raghu, Harini; Chan, Caleb; Chang, Patrick; Alberton, Valeria; Santiago, Mittermayer ; Aroca-Martinez, Gustavo; Alfaro, Jose; Furie, Richard A.; Larson, Christopher; Yoo, Bongin; Pendergraft, William F.; Malvar, Ana
The REGENCY trial (NCT04221477) demonstrated superiority of obinutuzumab (OBI) plus standard therapy (+ST) vs placebo (PBO) +ST in achieving complete renal response (CRR) at Week 76 (W76) in adults with active lupus nephritis (LN). It was postulated that OBI+ST would yield greater rates of histologic remission and kidney tissue-level B-cell depletion at W76 than PBO+ST, which would portend more favorable long-term kidney outcomes, such as reduced LN flare risk and preserved kidney function. These exploratory analyses aimed to evaluate histologic remission and kidney tissue-level B-cell depletion at W76 in patients treated with OBI+ST vs PBO+ST.
WCN26-6530 Colombian registry of glomerular diseases (REGLOCOL)
(International Society of Nephrology ISN, 2026) Aroca-Martinez, Gustavo; Figueroa-Millán, Christian; Daza, Jose Lucas; Cadena Bonfanti, Andres; Pérez-Jiménez, Valentina; Lasso-Latorre, Karen; Torres-Saltarín, Jaime; Puche-Carrascal, Eduardo; Ramírez, Roberto; Pérez Padilla, Rafael; Rodriguez, Liliana; Arcoa-Vidal, María; Fontalvo-Avila, Nicoll; Camargo-Rodriguez, Kanery; Vásquez-Obeso, Esteban
Glomerular diseases are significant causes of chronic kidney disease (CKD) and are categorized as either primary or secondary. FSGS, IgA nephropathy, and membranous nephropathy are the most common primary forms, while lupus nephritis predominates among secondary causes. The REGLOCOL registry seeks to define their epidemiology and clinical profile in Colombia.
WCN26-6812 Recurrent hypokalemia: the hidden footprint of an autoimmune distal renal tubular acidosis. Case report
(International Society of Nephrology ISN, 2026) Ipia-Ordóñez, Nasly; Aroca-Martinez, Gustavo; Benavidez-Solarte, Mario; Madroñero-Muñoz, Simón; Solarte-Ordóñez, Danilo; Pérez-Jiménez, Valentina; Lasso-Latorre, Karen
Distal renal tubular acidosis (dRTA) is an uncommon cause of hypokalemia and metabolic acidosis, especially among young adults. When associated with autoimmune diseases, it may represent the first manifestation of systemic involvement, as occurs in systemic lupus erythematosus (SLE) and Sjögren’s syndrome.
WCN26-432 Relationship between social vulnerability and evolution of glomerular filtration rate in patients with polycystic kidney disease
(International Society of Nephrology ISN, 2026) Arturo Dulce, Jaime; Guido Musso, Carlos; Aroca-Martinez, Gustavo; Alvarez Mora, Eveling Lisseth
Polycystic kidney disease (PCD) is the main hereditary kidney disease worldwide (1). It is characterized by the progressive formation of multiple renal cysts, which increase renal volume and replace the functional parenchyma, hypertension also occurs (2). Over time, glomerular destruction impairs filtration, leading to chronic kidney disease and the need for renal replacement therapy in certain cases (3). In terms of pathophysiology, PKD is mainly associated with mutations in the PKD1 and PKD2 genes, with autosomal dominant inheritance predominating. However, there are cases without mutations in these genes, affecting other loci conditioning an earlier and more severe presentation of the disease (4). PKD is a multisystem pathology with extra-renal cystic and non-cystic manifestations. The former include brain, liver, and gastrointestinal cysts. Non-cystic manifestations include aortic and cerebral aneurysms, heart valve abnormalities, colonic diverticula, and abdominal hernias (5)(6). The most frequent clinical manifestations, related to pathophysiology, are back pain, hematuria, urinary tract infections and lithiasis (7). Globally, an estimated 12 million people suffer from ERP, with approximately 600,000 cases in the United States (8). In the European Union, prevalence ranges from 2.41 to 3.89 cases per 10,000 population, and about 91.1 cases per million people require replacement therapy due to PKD (9). In Colombia, information is limited; the former Social Security Institute reported a prevalence of 4.6% in patients with stage 4 chronic kidney disease (10). In the context of chronic kidney disease, social vulnerability acts as a determining factor that significantly increases the risk of clinical decompensation, delay in diagnosis, limited access to appropriate treatments and, consequently, a higher mortality rate (11). The objective of this study was to make a correlation between ERP and the social vulnerability score (SOVI).
WCN26-436 De novo idiopathic nodular glomerulosclerosis in a kidney transplant patient
(International Society of Nephrology ISN, 2026) Dulce, Jaime A.; Cabarcas, Omar; Niño, Lucia; Aroca-Martinez, Gustavo
Chronic Kidney Disease is a condition characterized by a progressive and irreversible decrease in kidney function that can be caused by different etiologies, among which are primary or secondary glomerular diseases (1). Within renal replacement therapies; Transplantation is the modality that provides the greatest benefit in terms of quality of life and mortality. Renal graft survival can be affected not only by rejection and infections but also by relapse in the graft of a glomerular disease that affected the native kidney or otherwise, a de novo onset (2)(3). A study of 1505 transplant patients between 1988- 1997 with a diagnosis of confirmed glomerular disease documented that recurrence was the third most common cause of allograft loss at 10 years, after chronic rejection and death with a functioning allograft (4). It should be noted that live transplantation has better HLA compatibility and therefore greater graft survival, however increased rates of primary glomerulonephritis recurrence have been noted in this group of patients (5). Nodular glomerulonephritis is a histological lesion pattern characterized by the presence of hyaline deposits in the mesangial matrix with a nodule-like distribution; It also shows glomerular vascular involvement, and its usual clinical manifestation may be complete nephrotic syndrome or significant proteinuria. This type of injury is closely related mainly in patients with Diabetes Mellitus and smokers with a high rate of smoking activity. The de novo appearance of this type of lesion in the post-transplant period would constitute a primary form, whose presentation would be infrequent, corresponding to only 0.45% in the series published to date (6).
WCN26-6802 The impact of active Lupus Nephritis on work productivity in patients from a Latin American Lupus Cohort
(International Society of Nephrology ISN, 2026) Aroca-Martinez, Gustavo; Nieto, Romina; Quintana, Rosana; Pons-Estel, Guillermo; Pérez-Jiménez, Valentina; Pons-Este, Bernardo
Introduction: The Latin American Group for the Study of Lupus (GLADEL) 2.0 is an observational prevalent and incident cohort of patients with systemic lupus erythematosus (SLE) in Latin-American countries. Here we evaluated the work productivity and activity impairment (WPAI) in patients with active lupus nephritis (LN) at cohort entry and 12 months after treatment initiation according to their renal response.
WCN26-6861 Chronic kidney disease in vulnerable afro-descendant, indigenous, and agricultural communities in latin America
(International Society of Nephrology ISN, 2026) Aroca-Martinez, Gustavo; Villavicencio, Elba; Vital, Socorro; Rizo, Lilia; Rodríguez, Carolina; Molina, Daniel; Rico, Jorge; Dina-Batlle, Eliana; Bermudez, Valmore; Depine, Santos; Cadena, Andres; Pérez-Jiménez, Valentina; Aroca, María-Paula; Kanery-Camargo, Nicoll-Fontalvo; Lodi, Rubens
Chronic kidney disease (CKD) is a major global public health concern, affecting an estimated 13.4% of the world’s population (Lv & Zhang, 2019). Among afro-descendant, indigenous, and agricultural communities in Latin America, studies have identified a high prevalence of CKD, frequently undiagnosed and untreated (Correa-Rotter et al., 2014; Garza & Abascal Miguel, 2025; Ulasi et al., 2025). To effectively reduce the burden of CKD in these populations, it is essential to assess how the social determinants of health (SDOH) influence kidney health (Burgos-Calderón et al., 2021). The FRENEL study is an ongoing multicenter initiative, which to date has screened 4,876 participants from vulnerable agricultural, indigenous, and afrodescendant communities in Latin America
WCN26-8271 Social vulnerability and lupus nephritis clustering in Barranquilla, Colombia: integrating clinical registry data with a population vulnerability index
(International Society of Nephrology ISN, 2026) Aroca, Maria-Paula; Aroca-Martinez, Gustavo; Depine, Santos; Camargo- Rodriguez, Kanery; Fontalvo Avila, Nicoll; Pérez-Jiménez, Valentina; Vasquez, Esteban; Cadena, Andres; Sarmiento, Joanny; Manjarres, Karen; Bermudez, Valmore
Introduction: Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), with its incidence and progression potentially influenced by structural socioeconomic inequalities. The Population Renal Health paradigm (Burgos-Calderón, Depine, and Aroca- Martínez, 2021) shifts from individual risk assessment to population and territorial vulnerability analysis by integrating social determinants of health (SDOH). To operationalize this approach, the Population Vulnerability Index (PVI) was developed as a quantitative geospatial tool that measures SDOH across the Colombian Caribbean region, enabling systematic comparison of territorial vulnerability. In parallel, the RENELUP registry collects and georeferences LN cases throughout Colombia. This study cross-references RENELUP data from the city of Barranquilla with PVI scores to examine how SDOH influence disease distribution patterns in this urban setting.
Frequency and associated factors of herpes zoster infection in SLE patients from Latin America: data from the GLADEL 2.0 cohort
(BMJ Group, 2026) Nieto, Romina; Hernández, Lucia; Scolnik, Marina; Maurelli, Laura; Gobbi, Carla; Saurit, Veronica ; Garcia, Lucila; Kisluk, Boris; Bertolaccini, Maria Constanza; Serna Gongora, Melissa Brenda; Gómez, Graciela N; Pisoni, Cecilia; Ralle, Ana Carolina ; Pirruccio, Paola; de Souza Barbosa, Vitalina; Gasparin, Andrese; Duarte, Angela; Alves Alvino, Laíssa Cristina; Borba, Eduardo F; Bonfá, Eloisa; Torres dos Reis Neto, Edgard; Bondi Peralta, Alexis; Massardo, Loreto; Aroca-Martinez, Gustavo; Iglesias Gamarra, Antonio; Cañas, Carlos A; Quintana López, Gerardo; Frederick Silvery, Leon; Maximiliano Martinez, Jose; Sánchez-Briones, Reyna; Pérez Cristóbal, Mario; Martín-Nares, Eduardo; Silveira, Luis H; García De La Torre, Ignacio; Ramírez Sánchez, Julio César; Esquivel-Valerio, Jorge Antonio; Losanto, Jhonatan; Vazquez, Marcos Aurelio; Alva Linares, Magaly; Ugarte-Gil, Manuel Francisco; Calvo-Quiroz, Armando; Polanco, Teresandris; Pizzarossa, Carina; Silveira, Gonzalo; Pons-Estel, Bernardo; Alarcon, Graciela S; Pons-Estel, Guillermo
Objective The aim of this study was to assess the epidemiological and clinical characteristics of herpes zoster (HZ) and to identify the factors associated with its first episode in Latin American SLE patients. Methods GLADEL 2.0 (Grupo Latino Americano De Estudio del Lupus) is a multiethnic, Latin American observational cohort of SLE patients. Demographic, clinical, laboratory, treatment and disease activity/damage data were compared between patients with and without HZ; its prevalence was assessed at cohort entry, incidence rates of first and recurrent HZ infections were calculated based on person-years of follow-up. Logistic regression was used to identify factors associated with HZ events, while Cox regression was used to determine the variables associated with time to first event. Results Among 1083 SLE patients, the HZ cumulative incidence after its diagnosis was 11.5%, with a prevalence of 8.6% at cohort entry. During 5-year of follow-up, the incidence of HZ was 2.9% and 16.8% patients had recurrent episodes. Patients with HZ showed higher frequencies of alopecia, psychosis and seizures, along with higher disease activity, damage accrual, proteinuria and higher daily prednisone doses prior to the event. Multivariate analyses identified female sex, higher SLE Disease Activity Index 2000 (SLEDAI-2K) and higher daily prednisone dose as independent predictors of HZ occurrence. Older age at diagnosis, psychosis, disease activity and a higher daily prednisone dose were associated with a shorter time to HZ onset. Conclusion In the GLADEL 2.0 cohort, the high burden of HZ in SLE, together with its association with active disease, corticosteroid exposure and neuropsychiatric manifestations, underscores the need for proactive risk stratification in clinical practice.
Renal Outcomes of GLP‑1 Receptor Agonists and Tirzepatide Across CKD Stages and Metabolic Phenotypes (Type 2 Diabetes and/or Overweight/ Obesity): A Scoping Review
(Springer Nature, 2026) Rico‑Fontalvo, Jorge; Daza‑Arnedo, Rodrigo; Elbert, Alicia; Correa‑Rotter, Ricardo; Dina‑Batlle, Eliana; Lorca‑Herrera, Eduardo; Proença de Moraes, Thyago; Sánchez‑Polo, Vicente; Builes‑Montaño, Carlos E.
Introduction: Diabetes mellitus is the leading global cause of chronic kidney disease (CKD) and end-stage renal disease. Although cardiovascular outcomes have improved substantially, renal risk remains high. Glucagon-like peptide 1 (GLP-1) receptor agonists and the dual GLP-1/GIP agonist tirzepatide have demonstrated potential cardiorenal benefits, but renal evidence has not been systematically mapped across CKD stages and metabolic phenotypes. This scoping review aimed to identify and describe clinical evidence on renal outcomes associated with GLP-1-based therapies in adults with type 2 diabetes and/or overweight/obesity, with or without CKD. Methods: Following the Joanna Briggs Institute framework and PRISMA-ScR guidelines (protocol: OSF.IO/SZ87J), we searched PubMed, Embase, and CENTRAL from inception to October 2025. Eligible studies included phase 2–4 randomized controlled trials (RCTs), post hoc RCT analyses, and comparative observational studies reporting kidney outcomes. Data were charted using a structured extraction form with AI-assisted screening and manual validation. Risk of bias and certainty were appraised using RoB 2, ROBINS-I, and GRADE frameworks. Results: Of 607 records identified, 35 studies met inclusion criteria. Randomized evidence supports renal benefits for semaglutide, dulaglutide, and liraglutide, including reductions in composite kidney outcomes and slower eGFR decline. Tirzepatide demonstrated consistent albuminuria reductions and attenuation of eGFR decline compared with insulin glargine. Efpeglenatide, cotadutide, exenatide, and lixisenatide showed class-consistent antiproteinuric effects. Observational data extended findings to real-world and advanced CKD populations. Across agents, renal benefits were partly independent of glycemic and weight effects. Conclusion: GLP-1-based therapies demonstrate consistent renoprotective signals across CKD stages and metabolic phenotypes, particularly in type 2 diabetes. Evidence is strongest for semaglutide and dulaglutide, with emerging data for tirzepatide and other incretin-based agents. These findings provide a structured evidence map to inform future consensus and clinical decision-making.
Apolipoprotein L1 (APOL1) and Nephropathy
(Società Italiana di Nefrologia, 2026) Yael Szyferman, Alanis; Kleppe, Soledad; Cristiano, Fabrizio; Conde-Manotas, Juan C.; Cadena-Bonfanti, Andrés; Aroca-Martinez, Gustavo; Musso, Carlos G.
Introduction. End-stage renal disease exhibits a disproportionate prevalence among Black individuals and older adults within the United States and worldwide. A significant genetic contributor to this disparity is the Apolipoprotein L1 (APOL1) gene, found exclusively in populations of African ancestry. Materials and Method. We aim to perform a narrative review regarding the current understanding of APOL1 and its complex role in kidney disease pathogenesis. Results. The G1 and G2 APOL1 risk alleles are strongly associated with an elevated risk for non-diabetic chronic kidney disease (CKD), including hypertensive nephropathy, focal segmental glomerulosclerosis, and HIV-associated nephropathy, in individuals who are homozygous or compound heterozygous for these variants. While 10-15% of African Americans carry two APOL1 risk alleles, approximately 80% remain disease-free, suggesting incomplete penetrance and the involvement of additional risk factors. In this condition, renal damage could be induced through different mechanisms such as altered cellular ion transport, mitochondrial dysfunction, and the requirement for additional stressors or “second hits”. Conclusion. The increased susceptibility to end-stage renal disease (ESRD) in individuals of African ancestry is influenced by variations in the APOL1 gene.
Metabolic kidney disease: a new concept in the interaction between Obesity, Prediabetes, Diabetes and Liver Dysfunction
(Società Italiana di Nefrologia, 2026) Rico Fontalvo, Jorge; Daza Arnedo, Rodrigo; Raad Sarabia, María; Jiménez, Javier; Montejo-Hernández, Juan; Rodríguez-Yánez, Tomas; José Soler, María; Sciarrone-Alibrandi, Maria Teresa; Fernando Rivera, Rodolfo
Metabolic abnormalities such as obesity, insulin resistance, prediabetes, type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD) increasingly contribute to chronic kidney disease (CKD). Although often treated as separate entities, these conditions share common mechanisms – including glomerular hyperfiltration, adipokine imbalance, chronic low-grade inflammation, endothelial dysfunction and lipid accumulation – that initiate and sustain renal injury long before classical CKD becomes clinically evident. The concept of Metabolic Kidney Disease (MKD) offers a unified framework that captures the continuum of renal involvement across the metabolic spectrum. Obesity- and prediabetes-related MKD frequently precede diabetic kidney disease, while MASLD – according to updated EASL-EASD-EASO guidelines – is a multisystem disorder with direct renal consequences. Mixed metabolic phenotypes further intensify metabolic stress, accelerating progression toward CKD. Recognising MKD has important clinical implications. Expanded screening strategies may identify early renal alterations in individuals with metabolic vulnerability who are not targeted by traditional CKD criteria. Integrating metabolic evaluation into nephrology practice may facilitate earlier, more holistic interventions and ultimately improve cardio-renal outcomes.
Efficacy and safety of finerenone in diabetic kidney disease: Latin American experience from FINDKDLATAM trial
(Baishideng Publishing Group Inc., 2026) Daza Arnedo, Rodrigo; Sánchez Polo, Vicente; Benavides Garcia , Jenniffer; Gutiérrez, Juan Felipe; Ramos Clason, Enrique; Domínguez, Daniel; Mera Rebutti, Giovany; Madrid Mancia, Carlos; Tabora López, Rene; Rocha Meza, Manuel; Tabora López, Dany; Muñoz Zambrano, James J; Lorca Herrera, Eduardo; Dina-Batlle, Eliana; Cieza Terrones, Michael; Proença de Moraes, Thyago; Rodriguez Yánez , Tomas; Osorio, Washington; Arellano Cabeza, Alyi; Rico-Fontalvo, Jorge
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) face high renal and cardiovascular risks. Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, has demonstrated efficacy in reducing these risks in clinical trials. However, its real-world safety and effectiveness remain underexplored in local settings. AIM To evaluate the real-world safety and effectiveness of finerenone in patients with T2DM and CKD across seven Latin American countries. METHODS We conducted an observational, multicenter, retrospective cohort study based on real-world data in 347 patients with T2DM and CKD [urinary albumin-creatinine ratio (UACR) > 30 mg/g]. Patients received finerenone (10 mg or 20 mg daily), and clinical and laboratory parameters were evaluated at baseline and after six months of treatment. RESULTS At baseline, median values (interquartile range) were: Glycated hemoglobin A1c 7.6% (6.8%-8.1%); estimated glomerular filtration rate 39.0 mL/minute/1.73 m2 (30.0-50.0); UACR 345 mg/g (189-760); systolic blood pressure 143 mmHg (130-160); diastolic blood pressure 79 mmHg (70-82); and serum potassium 4.4 mmol/L (4.1-4.7). After six months, significant reductions were observed: Glycated hemoglobin A1c to 7.0% (6.5%-7.9%); UACR to 81 mg/g (28-167); systolic blood pressure to 130 mmHg (120-140); and diastolic blood pressure to 73 mmHg (70-80). Serum potassium increased to 4.7 mmol/L (4.3-5.0), while estimated glomerular filtration rate remained stable at 41.6 mL/minute/1.73 m2 (27.0-52.0). CONCLUSION In our cohort of patients with CKD associated with T2DM, finerenone proved to be an effective short-term therapy for reducing albuminuria, demonstrating very good tolerance and a low risk of hyperkalemia

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