Kidney Week 2025 Early Program - Glomerular Diseases: 2025 Update-Treating Lupus Nephritis: What's New in the 2024 KDIGO Guidelines?

Video Transcription

Video Summary

Dr. Samir Parikh reviews what’s new in KDIGO 2024 lupus nephritis (LN) guidance and what may change next. Key updates include stronger emphasis on kidney biopsy reporting (NIH activity/chronicity indices) to distinguish active inflammation from irreversible chronic damage, and a steroid-limiting approach with lower starting doses and faster tapers supported by recent trials (BLISS-LN, voclosporin AURORA, obinutuzumab studies) showing acceptable response rates with less cumulative steroid exposure.<br /><br />He discusses expanded “triple therapy” options—adding either a calcineurin inhibitor (CNI; e.g., voclosporin) or B‑cell–targeted biologics (belimumab; newly approved obinutuzumab) to mycophenolate (or low-dose cyclophosphamide) plus reduced steroids. Post-hoc data suggest CNIs produce faster proteinuria reduction (especially with heavy proteinuria and preserved GFR), while B‑cell therapies may better reduce renal flares and preserve long-term eGFR, potentially improving kidney survival beyond short-term proteinuria endpoints. Safety signals are broadly similar, though infections increase with B‑cell depletion.<br /><br />He highlights therapies on the horizon (interferon blockade, plasma-cell targeting, complement inhibition, CAR‑T/bispecific approaches) and notes limited but emerging evidence for CKD-protective “foundational” therapies (SGLT2 inhibitors, MRAs) in LN.<br /><br />Finally, he addresses treatment duration (often ≥36 months, evidence-limited) and argues repeat biopsy may help guide immunosuppression withdrawal, since histologic activity can persist despite clinical remission and predicts flare risk. A question raises B‑cell counts as a possible future tool to individualize biologic dosing intervals.

Asset Subtitle

Samir Parikh

Meta Tag

Module GLOM

Speaker Samir Parikh

Keywords

KDIGO 2024

lupus nephritis

kidney biopsy

steroid-sparing therapy

triple therapy

voclosporin

belimumab

obinutuzumab