Daniel C Cattran, MD, FRCPC

Natural history and treatment of primary glomerulonephritis (GN)

Primary glomerulonephritis (GN) remains the most common cause of end stage renal disease between the ages of 5 and 45. Although each type has a different pathology we have found that certain 'in common' features allow us to predict at an early stage the patients that are at highest risk of progression.

The factors examined have included standard laboratory measures of renal function but we have also found unique elements such as certain variations in the genotype of the angiotensin gene segregating with patients that had a more rapid progression, we have also found that women seem to have a built in protection both in terms of incidence rate and severity of the renal disease process and currently studying potential mechanisms involved. this project involves both basic scientists (Jim Scholey) and translational research (Judy Miller).

We have recently completed a multi center (US and Canada) randomized clinical trial using the drug cyclosporine in patients with one of these GN types called focal segmental glomerulonephritis. This type is the most common variant in children and Afro-Americans of all ages that leads to renal failure. This is the first randomized trial in adults with this disease. We found a significant long term benefit to the drug.

Our current projects involve the use of a unique fish oil preparation in the treatment of young adults with another type of GN called IgA nephropathy. This study is sponsored by the National Institute of Health. We are the only non US center. This fish oil is compared to prednisone and to placebo in a randomized trail. The study is expected to last for 4 years and is currently about 50% complete.

We are also testing a new agent called CellCept (mycophenolate mofetil) in patients with certain types of GN resistant to all other drug therapy. We are the leading center with collaborating units at Columbia University in New York and at the John Hopkins University in Baltimore.

We have previously shown the influence of certain genotypes on progression in IgA nephropathy. We have developed a consortium of units to explore this in more detail. The units participating include ones from Australia, Scotland and Finland. We expect to have the largest database in the world in IgA nephropathy by the end of this project.

We have just received 5 years of funding from CIHR to study the effects of vitamin therapy on homocysteine levels and how this might effect slowing of progression of diabetic kidney disease. The PI is Dr. William Spence (London) and co PI's include Dr. A. House (London) and Dr. D. Churchill (Hamilton). The majority of these studies have sprung from the Metropolitan Toronto GN Registry. This data collection, analysis and clinical trial unit has been stationed at the Toronto General Hospital since its inception in 1974. It was unique in the world at that time but now has a number of units in the UK, Spain, USA and the Philippines that emulate our original structure.

For a list of Dr. Cattran's publications, please visit PubMed or Scopus.

Professor, Faculty of Medicine, University of Toronto