KDIGO maps where B-cell therapy works in glomerular disease, and where it does not

The edition in brief

The nephrology harvest was thin today, so this edition reports the strongest recent work with its real publication dates rather than manufacturing news. A KDIGO Controversies Conference report from March sets out how differently B-cell-targeted therapy performs across glomerular diseases: rituximab has limited efficacy in IgA nephropathy where BAFF, APRIL and anti-CD38 agents show promise; anti-CD20 is first-line in membranous nephropathy with most patients reaching at least partial remission by 18 months; rituximab prevents relapse transiently in steroid-dependent nephrotic syndrome; obinutuzumab and CAR T cells look promising in lupus nephritis; and rituximab is established for both induction and maintenance in ANCA-associated glomerulonephritis. A real-world cohort of 25 mostly paediatric patients with C3 glomerulopathy or immune-complex membranoproliferative glomerulonephritis found urine protein-to-creatinine ratio fell 81% by six months on pegcetacoplan, with eGFR rising 12 mL/min/1.73 m² and no serious adverse events over 222 months of cumulative exposure. An immunogenicity study of the RSV vaccine Arexvy in 20 haemodialysis patients found antibody responses delayed to week eight and inversely related to dialysis duration. A preclinical study questions whether titrating vasopressin V2 receptor antagonists to maximum tolerated dose is the right strategy in polycystic kidney disease.