KDIGO guidelines glomerulonephritis

1. KDIGO guidelines glomerulonephritis Dr.

2. Overview • Rationale for requirement of guidelines • KDIGO: GN Guidelines • Scope • Clinical Nephrology Conferences (CNC) • November 21, 2010 • Current Evidence-based Management of IgA Nephropathy 

3. Rationale for Guidelines Requirements • Glomerulonephritis [GN] is a global health problem • Common cause of CKD and • Global threat to public health due to its increasing incidence, poor outcomes, and high associated costs

4. Rationale for Guidelines Requirements (Contd) • ESRD caused by GN • Direct health care costs • Most commonly affect people during the most productive period of their lives, the 2nd to 5th decades, when the socioeconomic impact on patients and families is devastating • Currently identified as a main priority for global nephrology care • Preservation of kidney function in patients with GN and • Prevention of progression to ESRD

5. GN: Variation in Etiology • Etiologies and patterns of GN vary substantially around the world, e.g. • GN associated with infection has high prevalence in many parts of the emerging world, although reducing prevalence in the developed world; and • Common patterns of ‘primary’ GN vary significantly in prevalence among different geographical regions and in different racial groups • But regardless of these variations, GN remains a major cause of morbidity and mortality all over the world and is probably underrepresented in most ESRD registries because of low detection rates and/or because some renal registries base diagnostic definitions purely on clinical presentation..

6. GN: Variation in Presentation • Clinical presentations of GN vary widely • Some people with GN are asymptomatic for long periods of time unless opportunistic testing identifies abnormal urinalysis or hypertension • Others develop an acute clinical illness – for example nephritic syndrome, nephrotic syndrome, visible haematuria, or acute kidney injury • Others present with slowly progressive proteinuric and/or hypertension associated CKD

7. KDIGO: Board Meeting • At its meeting in December 2008 the KDIGO Board determined that GN meets several criteria for developing clinical practice guidelines • Prevalent • Amenable to earlier detection and intervention • Imposes a heavy burden of illness (morbidity and mortality) • Incidence and prevalence in the pediatric and young adult age groups produces immense social and financial hardship not only on the patient but their families

8. KDIGO: Board Meeting • At its meeting in December 2008 the KDIGO Board determined that GN meets several criteria for developing clinical practice guidelines: • The cost per person of managing the disease is high, especially if ESRD is not prevented • There is considerable clinical practice variability in diagnosis and treatment • A clinical practice guideline has the potential to reduce this variability, improve patient outcomes, and reduce individual and societal costs

9. Guiding principles and process KDIGO: GN Guidelines • Scientific and methodological rigor • Using an evidence-based approach • Interdisciplinary approach • Work Group members will be chosen for their clinical expertise in the field of glomerular disease, their commitment to quality of care and their capacity for collaborative partnership working

10. Guiding principles and process KDIGO: GN Guidelines (Contd) • Independence of Work Groups • The work group will have independence and final responsibility in the formulation of recommendations. This will assure an unbiased approach to guideline development, without influence of organizations or industry • Openness of the guideline development process • Following their initial review by KDIGO Executive Committee and Board, the draft guideline will be subjected to a public review process that invites comment from groups and professionals whom the guideline will affect • Comments submitted at each phase of review will be carefully considered by the Work Group prior to publication of the final guideline

11. KDIGO: GN Guidelines • SCOPE • Diagnosis and treatment of common patterns of primary glomerulonephritis in adults & children, including: • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Membranoproliferative [mesangiocapillary] glomerulonephritis • IGA nephropathy • Infection related glomerulonephritis – including post-infectious GN and glomerular disease related to HBV, HCV, HIV infection

12. KDIGO: GN Guidelines (Contd) • SCOPE • Diagnosis and treatment of systemic immune disease in adults & children with glomerular or renovascular (?) involvement, including: [a] Lupus nephritis [b] Renal vasculitis [c] Goodpasture’s disease

13. KDIGO: GN Guidelines (Contd) • OUT OF SCOPE • Management of complications and risk factors for progression common to all proteinuric kidney diseases – including nephrotic syndrome, hypertension, proteinuria, and dyslipidaemia • Glomerular diseases associated with systemic disorders which do not have disease mechanisms founded in disordered immunity – including diabetic nephropathy, thrombotic microangiopathy, and amyloidosis

14. KDIGO: GN Guidelines (Contd) • Research Recommendations: • The evidence review process and the expertise of the Work Group will be utilized to identify gaps in knowledge regarding the diagnosis, evaluation, classification, prevention and management of glomerulonephritis and make research recommendations for implementation subsequent to the release of the guidelines

15. KDIGO: GN Guidelines (Contd) • Clinical Nephrology Conferences (CNC) • KDIGO: Glomerulonephritis Guidelines • November 21, 2010 | 10:00 AM - 12:00 PM

16. KDIGO: GN Guidelines (Contd) • Session Description • A KDIGO committee of nephrology experts combined with a professional review team has been examining the evidence base for the management of patients with primary glomerulonephritis over the past 18 months. • This CNC will explain how the evidence base is combined with the "grade" system to provide the current best approach to management of primary glomerulonephritides

17. KDIGO: GN Guidelines (Contd) • Session Objectives • Upon completion of this session, the participant will be able to: • 1) Understand the rigorous process used to develop guidelines in GN; • 2) Define the current status, level of evidence available and recommendations for treating patients with the most common progressive types of primary GN including focal and segmental glomerulosclerosis, IgA nephropathy, and membranous nephropathy; • 3) Describe the evidence in regards to management and the recommended treatment of minimal change disease in both children and adults including the steroid dependent and steroid resistant varients

18. KDIGO: GN Guidelines (Contd) • Current Evidence-based Management of IGA Nephropathy10:00 AM - 10:30 AMPhilip K.T. Li, MD • Current Evidence-based Management of Membranous Nephropathy10:30 AM - 11:00 AMVivekanand  Jha, MD • Current Evidence-based Management of FSGS/MCD in Children11:00 AM - 11:30 AMDebbie S. Gipson, MD • Current Evidence-based for Management of FSGS/MCD in Adults11:30 AM - 12:00 PMJai  Radhakrishnan, MD, FASN