pediatric kidney disease

Chronic kidney disease (CKD) and end-stage renal disease trials have been revitalized by SGLT2 inhibitors, which reduce CKD progression in both diabetic and non-diabetic patients through hemodynamic and anti-inflammatory mechanisms beyond glucose lowering. Targeting residual risk after SGLT2 and RAAS inhibition is the current frontier, with mineralocorticoid receptor antagonists (finerenone) already approved.

Active trials evaluate sparsentan (dual endothelin-angiotensin antagonist) in IgAN, iptacopan for complement-mediated nephropathy, bardoxolone for Alport syndrome, and dicarba-based gene therapy for FSGS. Urine biomarkers (UACR, NGAL) and eGFR slope are standard endpoints, with surrogate-to-hard endpoint validation ongoing.