On 2016 Feb 23, NephJC - Nephrology Journal Club commented:

This trial was discussed on Dec 23nd 2015 in the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available at the NephJC website . The discussion was quite detailed, with about 24 participants, including nephrologists, fellows, residents and patients. A transcript of the tweetchat are available from the NephJC website. The highlights of the tweetchat were:

• The authors should be commended for designing and conducting, and the German Federal Ministry of Education and Research for funding this trial.

• The choice of population was very astute, in whom there is genuine clinical equipoise on the value of added immunosuppression to optimal conservative management. Given the results, there was some discussion about whether, in the future, use of biomarkers or other risk scoring systems would allow selection of patients at higher risk of the outcomes. This was speculative in nature, and likely impractical considering that only 162 could be randomized for the most common primary glomerular disease.

• There were some minor quibbles (open label study design, use of 0.75gram/day rather than 1 gram/day threshold for proteinuria as an inclusion, use of dual renin-angiotensin system blockade in some patients) that were brought up, but no major weaknesses. This trial does definitively establish the lack of efficacy of immunosuppression in preventing kidney failure in this population as compared to optimal medical management alone.

Interested individuals can track and join in the conversation by following @NephJC, #NephJC, signing up for the mailing list, or visit the webpage at NephJC.com.

On 2016 Feb 23, NephJC - Nephrology Journal Club commented:

This trial was discussed on Dec 23nd 2015 in the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available at the NephJC website . The discussion was quite detailed, with about 24 participants, including nephrologists, fellows, residents and patients. A transcript of the tweetchat are available from the NephJC website. The highlights of the tweetchat were:

• The authors should be commended for designing and conducting, and the German Federal Ministry of Education and Research for funding this trial.

• The choice of population was very astute, in whom there is genuine clinical equipoise on the value of added immunosuppression to optimal conservative management. Given the results, there was some discussion about whether, in the future, use of biomarkers or other risk scoring systems would allow selection of patients at higher risk of the outcomes. This was speculative in nature, and likely impractical considering that only 162 could be randomized for the most common primary glomerular disease.

• There were some minor quibbles (open label study design, use of 0.75gram/day rather than 1 gram/day threshold for proteinuria as an inclusion, use of dual renin-angiotensin system blockade in some patients) that were brought up, but no major weaknesses. This trial does definitively establish the lack of efficacy of immunosuppression in preventing kidney failure in this population as compared to optimal medical management alone.

Interested individuals can track and join in the conversation by following @NephJC, #NephJC, signing up for the mailing list, or visit the webpage at NephJC.com.