Kidney Week 2025 Annual Meeting-Hot Topics in Lupus Nephritis

Video Transcription

Video Summary

The transcript captures an expert panel on “hot topics” in lupus nephritis (LN), focusing on treatment goals, the role of repeat kidney biopsy, targeting autoantibody production, and complement inhibition.<br /><br />Dr. Andreas Kronbichler reviews how LN trial endpoints vary (especially proteinuria and eGFR thresholds) and why traditional endpoints are imperfect due to biologic and measurement variability. He highlights that complete responses are uncommon, particularly in relapsing disease, and that each relapse markedly worsens long-term outcomes (CKD, kidney failure, mortality). Proposed 2025 goals emphasize preserving eGFR, preventing relapses, managing comorbidities (obesity, hypertension), and maintaining hydroxychloroquine use. He discusses “deep remission” (UPCR <0.15) as potentially associated with fewer flares, but questions feasibility in trials. Repeat biopsy may guide escalation or safe tapering, with ongoing studies (e.g., ReBioLup).<br /><br />Dr. Ayub argues biopsy is valuable not only for diagnosis but also because “silent” or low-grade proteinuria can still hide proliferative LN and chronic damage. She summarizes data showing discordance between clinical and histologic remission and that biopsy-guided immunosuppression withdrawal reduces flare rates. She reviews emerging molecular pathology and urine biomarkers (notably urine CD163 for activity and urine EGF for chronicity) as potential “liquid biopsy” tools.<br /><br />Professor Daniel Chan links improved serology (anti-dsDNA, complement) with better stability and outcomes. He contrasts therapies: CNIs reduce proteinuria but may not reduce flares or serology and carry nephrotoxicity/hypertension risk; belimumab and obinutuzumab improve serology and reduce flares but may increase infections (especially obinutuzumab). Future approaches include CAR-T and related B-cell/plasma-cell targeting.<br /><br />Professor Matthew Pickering reviews complement biology, potential pitfalls (immune complex clearance, C1q deficiency), and mixed trial results: anti-C5 and factor D inhibition have not shown clear efficacy in LN so far, while alternative pathway trials continue. The discussion emphasizes integrating clinical, serologic, and (ideally) tissue or biomarker evidence to guide individualized care.

Asset Subtitle

Moderator(s): Juan M. Mejia-Vilet, Sayna Norouzi

Presentation(s):

What Should Our Treatment Goals Be for Lupus Nephritis in 2025? - Andreas Kronbichler
Assessing Kidney Involvement in Systemic Lupus Erythematosus: Is a Biopsy Always Necessary? - Isabelle Ayoub
What Is the Best Way to Target Pathogenic Autoantibody Production in Lupus Nephritis? - Tak Mao Chan
Will Complement Inhibition Have a Place in the Treatment of Lupus Nephritis? - Matthew Pickering

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

Meta Tag

Date 11/7/2025

Pathway 1 Glomerular Diseases

Session ID 511012

Keywords

lupus nephritis

systemic lupus erythematosus

proteinuria endpoints

eGFR preservation

repeat kidney biopsy

histologic remission discordance

deep remission UPCR

relapse prevention

hydroxychloroquine maintenance

urine biomarkers CD163 EGF

B-cell targeting therapy

belimumab obinutuzumab

complement inhibition alternative pathway