Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Year in Review
  • Published:

Immune-mediated kidney disease in 2022

The evolving landscape of immune-mediated glomerular diseases

Nature Reviews Nephrology volume 19, pages 81–82 (2023)Cite this article

Subjects

Over the past year, trial data have emerged on therapeutic interventions in IgA nephropathy and lupus nephritis, including the effects of different doses of glucocorticoids and several novel targeted therapies. These data, in combination with the discovery of autoantibodies targeting nephrin in minimal change disease, can inform the management of immune-mediated glomerular diseases.

Key advances

  • A 6- to 9-month course of reduced-dose oral methylprednisolone is effective in lowering the risks of kidney failure in patients with IgA nephropathy and is associated with a lower risk of serious adverse effects compared with full-dose therapy3.

  • A 9-month treatment regimen with targeted-release budesonide, in addition to optimized supportive management, is well tolerated and can significantly reduce proteinuria and preserve eGFR in patients with IgA nephropathy at risk of disease progression6.

  • In active lupus nephritis, more patients had a complete clinical response when receiving an intensified anifrolumab regimen compared with placebo (difference not statistically significant); an intensified regimen might be required to achieve adequate serum anifrolumab levels8.

  • Most patients with lupus nephritis who discontinue maintenance immunosuppressive therapy after 2–3 years do not experience a relapse, and this observation supports the need to develop strategies to identify these patients at low risk of relapse9.

  • The discovery of anti-nephrin autoantibodies in a subset of patients with active non-congenital minimal change disease supports an autoimmune aetiology10.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Rauen, T. et al. Intensive supportive care plus immunosuppression in IgA nephropathy. N. Engl. J. Med. 373, 2225–2236 (2015).

    Article  CAS  Google Scholar 

  2. Lv, J. et al. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. J. Am. Med. Assoc. 318, 432–442 (2017).

    Article  CAS  Google Scholar 

  3. Lv, J. et al. Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: the TESTING randomized clinical trial. J. Am. Med. Assoc. 327, 1888–1898 (2022).

    Article  CAS  Google Scholar 

  4. Wheeler, D. C. et al. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy. Kidney Int. 100, 215–224 (2021).

    Article  CAS  Google Scholar 

  5. Fellström, B. C. et al. Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial. Lancet 389, 2117–2127 (2017).

    Article  Google Scholar 

  6. Barratt, J. et al. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int. https://doi.org/10.1016/j.kint.2022.09.017 (2022).

  7. Mejia-Vilet, J. M., Malvar, A., Arazi, A. & Rovin, B. H. The lupus nephritis management renaissance. Kidney Int. 101, 242–255 (2022).

    Article  CAS  Google Scholar 

  8. Jayne, D. et al. Phase II randomised trial of type I interferon inhibitor anifrolumab in patients with active lupus nephritis. Ann. Rheum. Dis. 81, 496–506 (2022).

    Article  CAS  Google Scholar 

  9. Jourde-Chiche, N. et al. Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial. Ann. Rheum. Dis. 81, 1420–1427 (2022).

    Article  CAS  Google Scholar 

  10. Watts, A. J. B. et al. Discovery of autoantibodies targeting nephrin in minimal change disease supports a novel autoimmune etiology. J. Am. Soc. Nephrol. 33, 238–252 (2022).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA

    Abdullah Jalal & Tingting Li

Authors
  1. Abdullah Jalal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tingting Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tingting Li.

Ethics declarations

Competing interests

T.L. receives research support from Travere Therapeutics, Genentech, Omeros Corporation and the US NIH/NIAID, and reports consultancy agreements with ChemoCentryx, Travere Therapeutics, Aurinia Pharmaceuticals, Calliditas Therapeutics and GlaxoSmithKline. A.J. declares no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jalal, A., Li, T. The evolving landscape of immune-mediated glomerular diseases. Nat Rev Nephrol 19, 81–82 (2023). https://doi.org/10.1038/s41581-022-00666-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41581-022-00666-w

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing