Improving outcomes in glomerular disease

Glucocorticoid exposure remains a major contributor to morbidity and mortality in patients with immune-mediated kidney disease. Recent clinical trials have tested novel potential therapies for these patients and showed that glucocorticoid doses can be reduced without compromising efficacy. Key advances C5a receptor antagonism with avacopan is effective in combination with cyclophosphamide or rituximab for inducing and maintaining remission in severe anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and reduces glucocorticoid requirements. Reducing glucocorticoid dose with rituximab for the induction of remission in AAV does not compromise short-term efficacy and reduces serious infections. Use of the calcineurin inhibitor voclosporin with mycophenolate mofetil (MMF) and glucocorticoids improves renal response in patients with class III–V lupus nephritis and eGFR >45 ml/min/1.73 m 2 . Obinutuzumab combined with MMF and glucocorticoids increases renal response in patients with class III–IV lupus nephitis. Inhibition of sodium–glucose co-transporter 2 with dapagliflozin in proteinuric IgA nephropathy improves renal outcomes.