Kidney Week 2025 Annual Meeting-Changing Landscape for Management of Vasculitis, Including the Robert W. Schrier, MD, Endowed Lectureship

Video Transcription

Video Summary

The session “Changing the Landscape on Management in Vasculitis” highlighted evolving goals in vasculitis care: achieving remission, safely stopping therapy, and improving outcomes through better risk prediction and targeted treatment.<br /><br />Ronald Falk presented data from a long-running UNC inception cohort of ANCA-associated vasculitis (AAV). Using strict clinical definitions, his group identified a substantial subset in long-term remission off therapy (LTROT)—about one-third of patients. Relapse risk is highest in the first 1–2 years after stopping treatment, but falls to ~1–2% after two years off therapy. Biomarkers to predict relapse remain lacking; patients’ self-assessment may detect flares earlier than clinicians. Falk emphasized “immunologic remission” as more than ANCA negativity or B-cell absence, citing mechanistic studies suggesting altered antigen presentation and distinct regulatory T-cell states in LTROT. He stressed that durable progress depends on trust-based patient–researcher partnerships.<br /><br />Dimitris Goumenos reviewed plasma exchange (PLEX) in AAV. Earlier trials suggested short-term renal benefit in severe renal disease, but PEXIVAS (700 patients) found no overall reduction in death or end-stage kidney disease with PLEX, while reduced-dose steroids lowered infection risk. Meta-analyses suggest PLEX may reduce short-term ESKD risk in higher-risk patients but increases serious infections. PLEX may still be considered in selected cases (severe renal failure, dialysis-dependent, rapidly rising creatinine, or hypoxemic diffuse alveolar hemorrhage), though how newer agents like avacopan will change this is uncertain.<br /><br />Dana Rizk discussed IgA vasculitis in adults, emphasizing limited adult-specific evidence and heavy reliance on IgA nephropathy extrapolation. Adult IgA vasculitis often has more active lesions (including crescents) and less chronic scarring at biopsy, yet some patients show an initial eGFR improvement followed by rapid decline. Shared and distinct genetic/pathogenic features vs IgA nephropathy were reviewed, underscoring the need for adult diagnostic criteria, biomarkers predicting nephritis, and inclusive trials across age groups.<br /><br />Samir Nasr updated cryoglobulinemic vasculitis/nephritis, noting a modern shift away from hepatitis C toward hematologic/MGRS-associated causes. Diagnosis is clinicopathologic; serum cryoglobulins can be negative, making EM and detailed immunofluorescence crucial. Outcomes are generally favorable with clone-directed therapy.

Asset Subtitle

Moderator(s): Silke Brix, Maria Jose Soler

Presentation(s):

ANCA-Associated Vasculitis: Lessons Learned from Patients in Long-Term Remission off Therapy: The Robert W. Schrier, MD, Endowed Lectureship - Ronald Falk
Is There Still a Role for Plasma Exchange in ANCA-Associated Vasculitis? - Dimitrios Goumenos
How Do We Improve Outcomes in IgA Vasculitis? - Dana Rizk
Cryoglobulinemia and Cryoglobulinemic Vasculitis - Samih Nasr

ASN gratefully acknowledges Otsuka America Pharmaceutical, Novartis, Astellas Pharma US, and several individuals for support of the Schrier Endowed Lectureship.

ASN thanks the European Renal Association (ERA) and ERA Ambassador, Dr. Dimitrios Goumenos.

Support for all sessions in the Glomerular Diseases Learning Pathway is provided by an educational grant from Vera Therapeutics, Inc.

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/7/2025

Pathway 1 Glomerular Diseases

Session ID 511014

Keywords

vasculitis management

ANCA-associated vasculitis (AAV)

long-term remission off therapy (LTROT)

relapse risk prediction

immunologic remission

patient-reported flare detection

UNC inception cohort

plasma exchange (PLEX)

PEXIVAS trial

reduced-dose glucocorticoids

end-stage kidney disease (ESKD)

diffuse alveolar hemorrhage

IgA vasculitis in adults

IgA nephropathy extrapolation

cryoglobulinemic vasculitis (MGRS-associated)