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Matthias Kretzler, Laura H. Mariani, Opponent's comments, Nephrology Dialysis Transplantation, Volume 30, Issue 6, June 2015, Page 891, https://doi.org/10.1093/ndt/gfv107a
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The CON position states that the foundation of high-quality care of patients with glomerular disease should be based on a comprehensive clinical assessment, adherence to best practice guidelines and also full leverage of current clinically available biomarkers. We have outlined these principles in our statements as the base on which all current research has to start. We stress that when assessing any new biomarker, the evaluation should begin by ‘barking at the right tree’, namely comparison against the current ‘gold’ standard clinical biomarkers, including renal pathology, serum creatinine and urine protein. Certainly, these benchmarks together with careful clinical assessments have been guiding us towards successful management in some of our patients, but there are too many cases where our standard assessment tools are less than ‘golden’ and fail us and our patients.
We need to do better, i.e. we need to be able to provide the right treatment for the right patient at the right time. Marked heterogeneity of prognosis and response to therapy exists in glomerular disease, even amongst patients with a shared renal pathological diagnoses, such as ‘primary FSGS’ or ‘diabetic nephropathy’. The many failed trials in these diseases are a testament to our inability to find and test the right drug in the right patient. The tools guiding future clinical management most likely will continue to include histology, established laboratory parameters and clinical judgment. But we have to expand our vision to identify the molecular pathway destroying nephrons in our patients and target them with the potent therapies currently emerging.
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