Contributing authors: Paul Hockings, Senior Scientific Advisor, Iris Friedli, Senior Director MR Imaging & Kanishka Sharma, Director MR Imaging
We were very excited to learn about how the latest advances are beginning to translate into meaningful scientific progress in kidney disease earlier this month at the European Renal Association (ERA) Congress in Glasgow, Scotland. Across sessions and presentations, a clear theme emerged: the field is moving beyond simply slowing disease progression and toward a deeper understanding of disease biology and future therapeutic possibilities.
Until quite recently, there had not been many too many advances in treatments for kidney diseases beyond symptom management. Now, with sodium-glucose cotransporter 2 (SGLT2) inhibitors for chronic kidney disease and targeted therapies for IgA nephropathy (IgAN) and C3 glomerulopathy (C3G), the field is moving quickly as the therapeutic landscape expands.
There was a lot of compelling science presented at the congress, but there were a few highlights that stood out for us: immunological approaches with B-cells in IgAN, patient-reported outcomes in the FLOW trial, and the therapeutic potential of xenotransplantation. We will discuss and reflect on these in this blog post.
Highlight 1: Targeting the immune system in IgA nephropathy
IgA nephropathy (IgAN) is an autoimmune kidney disease that, if left untreated, can progress to chronic kidney disease (CKD) or kidney failure. Until only a few years ago, treatment options for IgAN were limited to symptom management via renin-angiotensin-aldosterone system (RAAS) blockade. Today there are several therapies approved, submitted for approval and in late-stage development.
One highlight of the conference was the talk from Jonathan Barratt, ‘IgA nephropathy – reality 2025 and future perspective’. Building upon an understanding that IgAN is driven by dysregulation of the mucosal immune system, there are a range of novel mechanisms of action in development. Sopme examples include:
- Targeting the mucosa-associated lymphoid tissue
- Modulating key cytokines like BAFF (B cell-activating factor) and APRIL (A proliferation-inducing ligand)
- Inducing B cell depletion
- Altering the gut microbiota
- Blocking the homing of B cells to mucosal sites
- Depleting circulating immunoglobulin A (IgA) or galactose-deficient IgA1 (Gd-IgA1), or
- Targeting the complement immune system
Such a breadth of approaches showcases the possibilities for targeted interventions in a largely heterogeneous disease. But, as this session rightfully pointed out, in order to maximise the impact of these therapies, there is a true need for reliable biomarkers that can monitor response to therapy or identify patients earlier in the course of their disease progression, before significant kidney damage has occurred.
Highlight 2: Kidney function and beyond in CKD
While slowing decline in kidney function remains a central treatment goal in chronic kidney disease (CKD), clinical outcomes that measure how a patient feels, functions or survives remain the benchmark for determining true clinical benefit. This was lifted during the presentation of the latest analyses of the FLOW trial looking health-related quality of life (HRQoL) during the Late Breaking Clinical Trials 1 session.
The main results from FLOW have already been reported and have demonstrated clinical benefits with regards to reducing risk of major kidney disease events, risk of major cardiovascular events, and reducing all-cause mortality. However, what made this presentation a real highlight was the focus on patient-reported outcomes.
Study participants reported on key dimensions of daily life, including mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, and many of these were found to be improved with treatment. These findings suggest that the clinical benefits of treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist can extend beyond traditional measures of kidney function to aspects of life that matter directly to patients with CKD and type 2 diabetes (T2D), which often imposes a substantial burden on daily living. More broadly, this reflects an important acknowledgement of how treatment success could be defined in kidney disease. As therapeutic options expand, understanding how these treatments affect quality of life will be increasingly important for guiding clinical decision-making.
Highlight 3: Xenotransplantation and the future of organ replacement
The congress ended on a high note with a fascinating closing lecture: ‘From Science Fiction to Reality: The Xenotransplantation Revolution’. Having been involved in imaging kidney allografts in the past, it was a real highlight to see how this research has progressed.
The latest advances in genetic engineering have enabled transplantation of kidneys from pigs into human recipients, with modifications designed to reduce immune rejection and improve compatibility. Promising laboratory and early clinical findings suggest that xenotransplantation could become a viable treatment option for compatible patients.
There remain significant challenges with regards to ensuring long-term safety, managing immune responses, and monitoring outcomes in a robust way. The potential impact of this is significant, particularly amidst a global shortage of human donor organs. If successful, xenotransplantation could fundamentally change the landscape of kidney replacement therapy. It was an inspiring way to bring to a close a congress that was full of the latest advances in kidney research.
Closing thoughts
It was inspiring to see the breadth and depth of scientific research presented at this year’s ERA congress. We chose just a few highlights to reflect on in this blog post:
- Targeting the immune system in IgA nephropathy: a focus on B cell therapy demonstrated how a deeper understanding of disease biology can drive rapid and meaningful innovation, while also underscoring the need for earlier diagnosis and better biomarkers.
- Kidney function and beyond in CKD: the latest results from the FLOW trial highlighted the importance of looking beyond traditional clinical endpoints to measures such as health-related quality of life (HRQoL) to understand what brings the most clinical benefit for patients.
- Xenotransplantation and the future of organ replacement: the closing plenary offered a glimpse into a future where the limitations of human donor organ availability may no longer define treatment possibilities for kidney transplantation.
We are already looking forward to seeing how the field has progressed at next year’s ERA Congress in Rotterdam, The Netherlands.
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The views and opinions expressed in this article are solely those of the contributing author/s. These views and opinions do not necessarily represent those of Antaros Medical.
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