Nasim Wiegley @NWiegley

Nasim Wiegley is the Nephrology Fellowship Program Director, and the Director of the Glomerular Disease clinic at the University of California Davis School of Medicine. Dr. Wiegley completed her Internal Medicine Residency at the University of Illinois College of Medicine in Peoria, followed by a Nephrology Fellowship at the University of California, Davis School of Medicine. She further specialized in glomerular diseases by completing the Glomerular Disease Fellowship at GlomCon, where she now serves as the Editor-in-Chief of GlomCon Publications.
Her passions lie in clinical education and advancing care in glomerular diseases, serving as the site Principal Investigator for multiple clinical trials in this field at UC Davis.

The remaining competitors, our Left and Right Kidneys:

Team CAR-T for Autoimmune Disease vs Team MCD Diagnosis and Pathogenesis

In the rapidly advancing field of nephrology, a revolutionary discovery is making waves: anti-nephrin antibodies. These autoantibodies target nephrin, an essential protein in the podocytes’ slit diaphragm, and they are emerging as a groundbreaking tool for diagnosing and managing Minimal Change Disease (MCD). As nephrology continues to evolve, the emergence of these antibodies promises to transform our understanding, diagnosis, and treatment of MCD, offering new possibilities for precision medicine and patient care. Their journey to prominence has been paved by cutting-edge research, from early animal model studies to the pivotal clinical work of Watts et al and Hengel et al, who have clarified their role in the pathogenesis of podocytopathies.

As we reach the conclusion of NephMadness 2025, the excitement surrounding anti-nephrin antibodies is undeniable! These antibodies have the potential to become the leading contenders in the field of nephrology. But what makes anti-nephrin antibodies so intriguing? The answer lies in their specificity, utility, and their potential to transform patient management in nephrology.

The Power of Diagnostic Specificity

One of the most thrilling aspects of anti-nephrin antibodies is their exceptional diagnostic specificity for MCD. In the world of nephrology, where diagnosing glomerular diseases often requires an invasive kidney biopsy procedure, anti-nephrin antibodies stand out as a clear and reliable biomarker. Their diagnostic specificity for MCD exceeds 97%, establishing a new standard for detecting MCD. What makes this so remarkable is that MCD, which primarily affects children and young adults, has traditionally been a difficult disease to diagnose, with biopsies often required to confirm the condition. Traditional non-specific biomarkers, such as proteinuria and other markers of glomerular damage, overlap with a range of other kidney diseases, making them less reliable. In contrast, anti-nephrin antibodies have been found almost exclusively in MCD, which means they offer a highly specific, non-invasive diagnostic option. This has the potential to radically change the way we diagnose this disease, offering a tool that could eliminate the need for invasive kidney biopsies, especially in vulnerable populations.

For children and the elderly—two groups at particularly high risk for biopsy-related complications—this shift to a non-invasive diagnostic test is a game-changer. The ability to confirm an MCD diagnosis with just a blood test, as opposed to subjecting a patient to a biopsy, represents a significant advancement in patient care. It could reduce the physical and emotional burden on patients and families, enhance patient safety, and ultimately lead to faster diagnoses and better patient outcomes. The impact of this innovation cannot be overstated. It’s a crucial step forward in the field of nephrology and a major leap toward patient-centered precision medicine.

A Dynamic Monitoring Tool

Anti-nephrin antibodies are not just revolutionizing the diagnosis of MCD; they also have the potential to transform how we monitor disease progression and tailor treatment strategies for individual patients. Anti-nephrin antibodies have been shown to correlate with disease activity, providing clinicians with a dynamic measure that goes beyond the limitations of clinical symptoms and traditional non-specific biomarkers such as albuminuria. When patients respond to treatment, anti-nephrin antibody levels decrease, allowing clinicians to monitor the effectiveness of interventions.

This dynamic monitoring function makes anti-nephrin antibodies an exciting tool for personalized medicine. By offering a more individualized approach to treatment, clinicians can avoid the trial-and-error process of managing MCD and instead tailor therapies based on real-time data. The potential to adapt treatment plans to the changing levels of anti-nephrin antibodies could significantly improve patient outcomes, reducing the risk of relapses and helping patients achieve sustained remission more effectively.

A Parallel to Anti-PLA2R in Membranous Nephropathy

The potential of anti-nephrin antibodies has drawn comparisons to the groundbreaking anti-PLA2R antibodies used in the diagnosis and management of membranous nephropathy, a disease that similarly affects the glomerular filtration barrier. Just as anti-PLA2R antibodies have transformed the way we diagnose and manage membranous nephropathy, anti-nephrin antibodies are poised to have an equally transformative effect on MCD. Anti-PLA2R antibodies have become an indispensable tool for diagnosing membranous nephropathy, allowing for non-invasive, precise diagnosis and monitoring of disease activity. Similarly, anti-nephrin antibodies hold the promise of becoming a cornerstone biomarker in the management of MCD, offering nephrologists a powerful tool to diagnose, monitor, and track treatment efficacy in ways that were not previously possible.

What’s truly exciting is the potential for these antibodies to revolutionize not just diagnosis and monitoring, but also long-term management strategies for patients with podocytopathies. The increased specificity and accuracy of anti-nephrin antibodies mean that nephrologists will be able to make earlier and more accurate diagnoses, resulting in more timely and effective interventions.

Anti-Nephrin Antibodies in Transplant Nephrology

The role of anti-nephrin antibodies in transplant nephrology is equally thrilling. One of the most significant challenges in kidney transplantation is the recurrence of podocytopathies, such as MCD and FSGS, in the allograft kidney. In patients at high risk of recurrent disease, elevated pre-transplant anti-nephrin antibody levels have been associated with post-transplant FSGS recurrence. This discovery is of paramount importance, as it provides clinicians with an early warning sign that could prevent graft loss by allowing for more proactive management. With this information in hand, nephrologists can make early adjustments to immunosuppressive therapy or intervene in other ways to prevent the disease from damaging the graft.

A Future of Precision Medicine

The ability of anti-nephrin antibodies to serve as both a diagnostic and monitoring biomarker is a game-changer in nephrology. They represent a huge leap forward in our ability to diagnose diseases earlier, treat them more effectively, and monitor disease progression with remarkable precision. As we move toward a future of precision medicine, where treatments are tailored to the individual patient, these antibodies offer an invaluable resource. With anti-nephrin antibodies, we can now diagnose MCD earlier, monitor it more accurately, and individualize treatments based on real-time data, ensuring that every patient receives the best care possible.

As NephMadness 2025 looks to crown a new champion in the field of nephrology, it’s clear that these antibodies are not just a passing trend—they are a transformative force in nephrology, setting the stage for a new era in the way we manage MCD and beyond. The future is here, and anti-nephrin antibodies are poised to take the management of glomerular disease to new heights!

Copyright: Mateusz Lachowski Photo / Shutterstock

– Guest Post written by Nasim Wiegley

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

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