[Treatment principles and long-term management of glomerulonephritides]

Glomerulonephritides (GNs) are a heterogeneous group of mostly immune-mediated kidney diseases and are among of the most common causes of chronic renal failure, including end-stage renal disease. Advances in pathophysiology, histopathology, and immunotherapy have led to more differentiated therapeutic approaches.

To present evidence-based treatment principles and concepts for long-term care in primary and secondary GNs, with particular reference to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

Review based on international guidelines (KDIGO), national guidelines, randomized controlled trials, meta-analyses, and current publications.

The treatment of glomerular diseases is based on a combination of supportive measures, disease-specific immunosuppression, and adjuvant therapy (e.g., lipid, anticoagulation, and vaccination management), as well as structured, long-term care. New pathogenesis-oriented therapies, in particular complement inhibitors and B cell-targeted strategies, are expanding the therapeutic spectrum and enabling low-steroid or steroid-free concepts.

The long-term prognosis for GN patients depends largely on early diagnosis, correctly stratified initial therapy, consistently implemented supportive measures, close follow-up care, and lifelong nephrological care. Supportive measures are at least as relevant to prognosis as specific immunosuppression. Controversy exists in particular regarding the intensity, duration, and sequence of immunosuppressive therapy, as well as the cost-effectiveness of new biological and complement-targeted substances.