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Immune-mediated kidney disease in 2022

The evolving landscape of immune-mediated glomerular diseases

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.

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Correspondence to Tingting Li.

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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.

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Jalal, A., Li, T. The evolving landscape of immune-mediated glomerular diseases. Nat Rev Nephrol 19, 81–82 (2023).

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