Improving outcomes in glomerular disease.

Glucocorticoid exposure remains a major contributor to morbidity and mortality in patients with immune-mediated kidney disease. Recent clinical trials have tested novel potential therapies for these patients and showed that glucocorticoid doses can be reduced without compromising efficacy. Key advances: C5a receptor antagonism with avacopan is effective in combination with cyclophosphamide or rituximab for inducing and maintaining remission in severe anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and reduces glucocorticoid requirements. Reducing glucocorticoid dose with rituximab for the induction of remission in AAV does not compromise short-term efficacy and reduces serious infections. Use of the calcineurin inhibitor voclosporin with mycophenolate mofetil (MMF) and glucocorticoids improves renal response in patients with class III–V lupus nephritis and eGFR >45 ml/min/1.73 m2. Obinutuzumab combined with MMF and glucocorticoids increases renal response in patients with class III–IV lupus nephitis. Inhibition of sodium–glucose co-transporter 2 with dapagliflozin in proteinuric IgA nephropathy improves renal outcomes. [ABSTRACT FROM AUTHOR]