Kidney Week 2025 Early Program - Glomerular Diseases: 2025 Update-Treating ANCA-Associated Vasculitis: Current Status and Future Perspective

Video Transcription

Video Summary

Dr. Thuvuru Gita reviews current management and future directions for ANCA-associated vasculitis (AAV), emphasizing that despite modern therapy, patients still have reduced long-term survival, with low baseline GFR predicting worse outcomes. Infection is the leading cause of early mortality, highlighting the importance of prevention.<br /><br />Treatment success includes disease control, comorbidity risk assessment, and quality-of-life improvement. Induction therapy options include rituximab or cyclophosphamide (with glucocorticoids), sometimes combined in severe disease; mycophenolate may be effective in selected patients. Reduced-dose steroid regimens (PEXIVAS/LOVAS) provide similar efficacy with fewer severe infections and are now recommended.<br /><br />Plasma exchange (PLEX) remains controversial: PEXIVAS showed no overall benefit for death/ESKD, but meta-analyses suggest possible short-term kidney benefit at the cost of more infections. Guidelines suggest considering PLEX in severe renal failure and using it definitively for “double-positive” ANCA + anti-GBM disease; routine use in alveolar hemorrhage is not supported, though some clinicians still use it in extreme cases.<br /><br />Avacopan is recommended for patients at high steroid-toxicity risk and may improve eGFR recovery and sustained remission; real-world data suggest benefit even with very low baseline GFR.<br /><br />For maintenance, rituximab is favored over azathioprine, but optimal duration should be individualized. Future therapies target B cells and complement pathways (e.g., obinutuzumab, combination B-cell strategies, factor B/C5a inhibitors).

Asset Subtitle

Duvuru Geetha

Meta Tag

Module GLOM

Speaker Duvuru Geetha

Keywords

ANCA-associated vasculitis (AAV)

rituximab

cyclophosphamide

reduced-dose glucocorticoids (PEXIVAS/LOVAS)

plasma exchange (PLEX)

avacopan (C5a receptor inhibitor)

maintenance therapy and emerging B-cell/complement targets