How to Cure Autoimmune GN and Podocytopathies.

Area of Science:

• Nephrology
• Immunology
• Internal Medicine

Background:

• Autoimmune glomerulonephritis (GN) and podocytopathies are immune-mediated kidney diseases.
• Current prognosis and immunotherapy intensity rely on proteinuria and histotypes.
• Renin-angiotensin system and SGLT2 inhibitors are often considered solely supportive care.

Purpose of the Study:

• To refine treatment concepts for GN and podocytopathies based on shared pathophysiology.
• To establish disease acuity as the primary determinant of therapy intensity.
• To integrate chronic kidney disease (CKD) management into treatment priorities.

Main Methods:

• Review of current understanding of autoimmune GN and podocytopathies.
• Analysis of disease acuity (rapidly progressive, relapsing, chronic) to guide therapeutic priorities.
• Evaluation of B cell-targeting therapies and combination therapies based on disease complexity.
• Incorporation of KDIGO CKD risk matrix and recommendations for management.

Main Results:

• Disease acuity dictates distinct therapeutic priorities: immediate complement inhibition/antibody removal for rapidly progressive GN, long-term B cell-targeting monotherapy for single-clone relapsing diseases, and combination therapies for multi-antigen diseases.
• Chronic kidney disease (CKD) management is a critical priority, becoming primary in chronic GN and secondary in relapsing GN/podocytopathies.
• Proteinuria alone is insufficient for treatment decisions, as it can indicate disease activity, CKD, or both.

Conclusions:

• Treatment strategies for GN and podocytopathies should be redefined based on disease acuity and underlying autoimmune pathomechanisms.
• Immunotherapy intensity should be tailored to specific disease characteristics, not solely proteinuria levels.
• Integrated CKD care is essential for better long-term outcomes in patients with autoimmune kidney diseases.