Intervention: Bardoxolone methyl
Trial phase: Phase 2
SMILES: COC(=O)C12CCC(C)(C)CC1C1C(=O)C=C3C4(C)C=C(C#N)C(=O)C(C)(C)C4CCC3(C)C1(C)CC2
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 26
Group description: Participants with IgA nephropathy (IgAN) who received bardoxolone methyl capsules at a starting dose of 5 mg and titrate up to a maximal dose of 20 mg (participants with UACR less than or equal to 300 mg/g) or 30 mg (participants with UACR greater than 300 mg/g) daily.

Bardoxolone methyl capsules: Bardoxolone 5 mg capsules
Eligibility criteria:
Inclusion Criteria:

Male and female patients 18 ≤ age ≤ 65 upon study consent;
Screening eGFR (average of Screen A and Screen B eGFR values) ≥ 30 and ≤ 90 mL/min/1.73 m2. The two eGFR values collected at Screen A and Screen B visits used to determine eligibility must have a percent difference ≤ 25%;
Albumin to creatinine ratio (ACR) ≤ 2500 mg/g at Screen B visit;
If receiving an angiotensin-converting enzyme (ACE) inhibitor and/or an angiotensin II receptor blocker (ARB), patients should be prescribed the maximally tolerated labeled daily dose (MTLDD) for at least 6 weeks prior to the Screen A visit;
For patients enrolling in T1D Cohort: Diagnosis of type 1 diabetes confirmed by fasting C-peptide level. Diagnosis must have been made ≤ 35 years of age; and prescribed stable dose of insulin to maintain adequate glucose control for at least 6 months prior to the Screen A visit;
For patients enrolling in IgAN Cohort: Biopsy-confirmed IgA nephropathy;
For patients enrolling in FSGS Cohort: Biopsy-confirmed FSGS that is not due to known secondary causes including morbid obesity, decreased renal mass, viral infections, drug-induced nephrotoxicity, or prior history of vasculitis;
For patients enrolling in ADPKD Cohort: Genetic confirmation of PKD1 mutation;
Adequate bone marrow reserve and organ function at the Screen A visit as follows: Hematologic: Absolute neutrophil count > 1.5 x 109/L, platelets > 100 x 109/L, hemoglobin (Hgb) ≥ 9 g/dL; and Hepatic: Total bilirubin (TBL) ≤ 1.5 times the upper limit of normal (ULN), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 1.5 times ULN.

Exclusion Criteria:

Kidney or any other solid organ transplant recipient or a planned transplant during the study;
B-type natriuretic peptide (BNP) level > 200 pg/mL at Screen A visit;
Acute dialysis or acute kidney injury within 12 weeks prior to Screen A visit or during Screening;
Serum albumin < 3 g/dL at Screen A visit;
Systemic immunosuppression for more than 2 weeks, cumulatively, within the 12 weeks prior to randomization or anticipated need for immunosuppression during the study;
For patients enrolling in IgAN Cohort: Systemic manifestations of Henoch-Schonlein purpura within 1 year prior to Screen A visit; or have used belimumab, eculizumab, or rituximab within 6 months prior to Screen A visit;
For patients enrolling in ADPKD Cohort: Receiving tolvaptan;
Cerebrovascular event (stroke, transient ischemic attack) or aneurysm within 6 months prior to Screen A visit or during Screening;
History of clinically significant left-sided heart disease and/or clinically significant cardiac disease;
Uncontrolled systemic hypertension;
Systolic BP < 90 mm Hg at Screen A visit after a period of rest;
History of malignancy within 2 years prior to Screen A visit, with the exception of localized skin or cervical carcinomas;
Uncontrolled diabetes (HbA1c > 10.0%) at Screen A visit;
Untreated or uncontrolled active bacterial, fungal, or viral infection;
Participation in other interventional clinical studies within 30 days prior to Day 1;
Unwilling to practice acceptable methods of birth control (both males who have partners of child-bearing potential and females of childbearing potential) during Screening, while taking study drug, and for at least 30 days after the last dose of study drug is ingested;
Women who are pregnant or breastfeeding.