Introduction: Glomerular Disease Update for the Clinician

Introduction

With this issue, the Clinical Journal of the American Society of Nephrology launches the latest in its educational series: a Glomerular Disease Update for the Clinician. Substantial progress has been made in our understanding of the underlying disease mechanism for a number of glomerular diseases. These advances have, in turn, set the stage for improved diagnostic and treatment considerations. To illustrate these advances, a panel of distinguished authors have composed a suite of comprehensive reviews (Table 1) that we expect will serve as both an update for the seasoned clinician, and as educational insight for trainees.

The series begins with five introductory pieces designed to highlight the elements driving progress in the field. The initial review is an overview discussing the cells or “players” involved in glomerular pathology and disease. The authors discuss the specialized role of mesangial cells, endothelial cells, podocytes, and parietal epithelial cells within the glomerulus. Next, the role of complement in glomerular disease is considered, with examples of how complement may mediate glomerular disease and become a target for therapeutic intervention. A subsequent article considers the “omics” and state of the art bioinformatics tools that have pushed the study of glomerular disease further into the 21st century. The introductory section closes with two important patient-centered reviews. The first review addresses the issues pertaining to performing clinical trials in rare disease and how patient registries may be leveraged. The second patient-centered review discusses the role of patient-reported outcomes (PRO) in the study of glomerular disease. The authors review whether PROs are appropriate in the study of glomerular disease and highlight opportunities for incorporating PRO measures into clinical care and research.

In subsequent issues, 12 individual glomerular diseases are reviewed with attention to both epidemiology and pathology. Pertinent clinical controversies are discussed, as well as the most current, best approach to diagnosis and management.

This series highlights the remarkable progress that has been made in our understanding of the glomerular diseases. It is the editors’ hope that it will also serve as a springboard for a discussion on future directions as we move toward optimal care for patients with glomerular disease.