Laboratory of nephrology and kidney transplantation

The Nephrology and Kidney Transplantation Laboratory hosts a broad range of research projects focused on tightly integrated topics involving both basic science and clinical practice. The laboratory research projects launched each year, along with various clinical trials in which patients can be enrolled and treated with innovative therapies, ensure high-level scientific clinical activity based on the continuous updating of diagnostic and therapeutic procedures.

The five main branches of nephrology that our team focuses on, along with their respective active research projects, are:

Transplantation      

Kidney transplant represents the best therapy currently available for patients with advanced stage 5 chronic kidney disease. Over the years, the transplant population has become increasingly complex. This change is due in part to the improved efficacy of medical therapies for the prevention and treatment of kidney damage—which lead to the exhaustion of renal function at more advanced ages and as a result of more complex comorbidity processes—and on the other hand to the increasingly frequent condition of hyperimmunity, which represents an additional challenge.

Our research in the field of transplantation focuses on improving the approach to patients with complex conditions, both from an immunological, hemodynamic, and metabolic perspective, and often in advanced age. The group's research areas are therefore oriented towards innovative approaches for improving transplant prognosis, such as monoclonal antibodies, desensitization techniques, apheresis procedures, and hemodynamic supports, which help mitigate the negative effects of pre-existing conditions.

• Chronic antibody-mediated rejection: treatment with tocilizumab. Use of monoclonal antibodies in kidney transplantation, both in the pre- and post-transplant phases, in the context of diseases associated with dysregulation of the complement system (thrombotic microangiopathy, recurrence of nephropathies, ischemia-reperfusion injury) and in chronic antibody-mediated rejection
• Management of hyperimmunized patients on the transplant waiting list through third-level immunogenetic studies and innovative desensitization strategies
• Use of novel antiproteinuric and nephroprotective drugs in kidney transplant patients
• Study of possible molecular and cellular urinary markers of renal damage/regeneration post-transplant
• Fecal microbiota transplantation after kidney transplant: study in the context of recurrent urinary tract infections

Dialysis                     

Dialysis is currently the primary therapy able to compensate for the absence of function in a vital organ like the kidney. While the nephrology field aspires to a world without dialysis, this goal is not yet within reach. Dialysis remains a vital and unavoidable treatment for many patients, especially those ineligibles for transplantation due to immunological issues or high-risk comorbidities.

Our research in the field of dialysis is aimed at the personalization of treatments, focusing on ensuring hemodynamic stability during the procedure, on the use of filtration membranes that are as inert as possible, and on biofeedback mechanisms that allow the treatment to become more physiological, with reduced risks of morbidity and mortality. These goals apply both to hemodialysis and to peritoneal dialysis, in which—despite the absence of artificial membranes—hyperosmotic substances are used that can activate various factors, such as interleukin-6. Our team is interested in innovative dialysis techniques such as adsorption and immunoadsorption to address the challenges of treating acute patients.

• Investigation of the immunomodulatory and anti-inflammatory potential of dialysis membranes in both acute and chronic patients
• Evaluation of emerging therapies for managing cardiometabolic complications in dialysis patients
• Application of apheresis techniques in patients with peripheral artery disease and hyperlipidemia
• Use of extracorporeal therapies for the management of acute liver failure and hyperbilirubinemia
• Implementation of extracorporeal treatments for acute drug and toxin intoxications

Primary and Secondary Glomerular Diseases
In recent years, there has been noteworthy progress in the treatment of glomerular kidney diseases, both primary and secondary. This advancement has been made possible by the identification of key biological pathways involved in disease pathogenesis. Most of these conditions are closely linked to immune system dysregulation. Notably, progress in oncology research — particularly in hematological malignancies — has greatly contributed to these therapeutic breakthroughs.

Our research in the field of glomerular diseases develops around the translation into nephrology of drugs traditionally used in oncological conditions, with the use of various therapeutic agents that have already shown great efficacy over the past several years. The diseases involved are numerous, including IgA mesangial deposit nephropathy, lupus nephritis, ANCA-associated vasculitis, membranous glomerulonephritis, as well as minimal change disease and focal segmental forms. These conditions have found extraordinary potential therapeutic agents in drugs that act, depending on the case, either in a more specific or in a broader and cross-cutting way. It began twenty years ago with Rituximab and has reached today new molecules such as obinutuzumab, ofatumumab, belimumab, voclosporin, carfilzomib, and many other promising drugs.

• Novel therapies in the management of ANCA-associated vasculitis
• Pathogenesis and treatment of membranous glomerulopathy
• IgA nephropathy: immunosuppressive treatment tailored to clinical presentation and MEST-C classification
• Emerging anti-complement therapies: applications in the management of vasculitis, IgA nephropathy, lupus nephritis, and C3 glomerulopathy
• Daratumumab in the treatment of MGRS not related to multiple myeloma (such as cryoglobulinemia and PGNMID)

Chronic Kidney Disease

For over two decades, blocking the renin–angiotensin–aldosterone system was the only treatment strategy adopted in nephrology for chronic kidney disease This approach became so entrenched that kidney damage no longer had a direct clinical counterpart within nephrology itself, as guidelines had incorporated this therapy primarily as part of cardiovascular and antihypertensive prevention. In recent years, however, this landscape has shifted dramatically. Clinical trials on SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, along with data on GLP-1 receptor agonists, the introduction of novel potassium-binding resins, and novel agents for anemia have brought alternative therapeutic options that currently represent the cornerstones of treatment for patients with chronic kidney disease.

Our research in the field of chronic kidney disease focuses both on well-established therapeutic approaches and on emerging strategies currently under investigation. Our goal is to integrate these options into clinical practice, with a strong emphasis on treatment specificity and personalization. Another major area of interest is mineral metabolism disorders involving the kidney–bone axis. This axis is regulated by the kidney, and in patients with advanced renal damage and related alterations, novel and innovative therapeutic options are now available, including romosozumab, abaloparatide, and denosumab.

• Optimization of nephroprotective therapy in patients with chronic kidney disease with and without diabetes mellitus
• Nephroprotective therapy in chronic kidney disease associated with heart failure
• Treatment of bone disease associated with chronic kidney disease and organ transplantation
• Treatment of hyperparathyroidism before and after kidney transplantation

Nephrology and Rare Diseases

Rare diseases are a key therapeutic focus in nephrology. First, because they are numerous; second, because they carry a significant burden in terms of both care and healthcare costs. Conditions such as autosomal dominant polycystic kidney disease, Alport syndrome, nephronophthisis, Fabry disease, Behçet’s syndrome, tuberous sclerosis, and primary hyperoxaluria are just a few examples of clinical entities which, despite their heterogeneity, have a non-negligible prevalence in the general population. Importantly, for each of these diseases, new treatments, therapeutic hypotheses, and clinical approaches are emerging — requiring appropriate management in specialized centers connected to international networks such as ERKNet (European Rare Kidney Disease Reference Network). Within this framework, our center in Bologna serves as a reference point for both the clinical and research management of rare kidney diseases.

• Therapies for hepatorenal polycystic disease
• Histopathology of Fabry disease
• Analysis of renal lesions in tuberous sclerosis
• Ultrastructural analysis of the glomerular basement membrane in thin basement membrane disease

Other members

• Valeria Aiello

• Lorenzo Gasperoni

• Valeria Pizzuti

Collaborators

• Francesco Alviano
• Massimimiliano Bonafè
• Laura Bonsi
• Antonietta D’Errico
• Rita Golfieri
• Gianandrea Pasquanelli
• Matteo Ravaioli
• Piera Versura

Representative collaborations in international networks include:

• Columbia University and Mount Sinai of New York, University of Alabama, Miami University (USA)
• Monash University of Melbourne (Australia)
• Hôpital di Le Mans di Parigi (Francia)
• King’s College of London (UK)
• Clínica Universidad de Navarra, Pamplona (Spagna).