Targeting B cells in immune-mediated kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

作者：Jürgen Floege, Isabelle M. Ayoub, Silke R. Brix, Kirk Nicholas Campbell, Richard Alan Furie, Patrick H. Nachman, Sydney CW Tang, Nicola M. Tomas, Marina Vivarelli, Michael Cheung, Jennifer M. King, Morgan Erika Grams, Michel Jadoul, Brad H. Rovin, Valeria Gabriela Alberton, Andrea Angeletti, Jennifer L. Barnas, Jonathan Barratt, Peter Boor, Roberto Caricchio, Daniel T.M. Chan, Eugene Yu-hin Chan, Manuela Colucci, Anne Davidson, Nathan Denlinger, Raphaël Duivenvoorden, Marie Eggers, Alessia Fornoni, Eleni Frangou, George E. Georges, Andre Gontijo, Shaun W. Jackson, Brittan Kopittke, Maria José Leandro, Nelson Leung, Adrian Liew, Ana Malvar, Juan Manuel Mejía-Vilet, Peter A. Merkel, Irene L. Noronha, Michelle M. O’Shaughnessy, Ioannis Parodis, Amber S. Podoll, Anjay Rastogi, Dario Roccatello, Jorge E. Rojas-Rivera, Barbara Seitz-Polski, Saira Z. Sheikh, Dan Suan, Rita S. Suri, Vladimír Tesař, Naotake Tsuboi, Augusto Vaglio, Christoph Wanner, Muh Geot Wong, Hui-Kim Yap, Hong Zhang, Ming-hui Zhao · 发表于：Kidney International · 年份：2026 · DOI：10.1016/j.kint.2026.02.029 · 被引用次数：4 · 研究领域：Renal Diseases and Glomerulopathies、Renal Transplantation Outcomes and Treatments、Psoriasis: Treatment and Pathogenesis

Treatments that deplete or modulate B cells are in use or being investigated for several immune-mediated glomerular diseases. Kidney Disease: Improving Global Outcomes (KDIGO) convened a Controversies Conference in Panama City, Panama, in June 2025 to review current evidence and identify key gaps in knowledge and research needs to effectively apply such therapies. Availability, effectiveness, and safety of B cell-targeted therapies vary substantially across glomerular diseases. In IgA nephropathy, anti-CD20 therapy (rituximab) has shown limited efficacy, although inhibitors of survival factors BAFF (B cell activating factor) and APRIL (a proliferation-inducing ligand) and anti-CD38 antibodies can lead to reduction in proteinuria and reduction in decline in estimated glomerular filtration rate. In contrast, for membranous nephropathy, anti-CD20 antibodies have become first-line therapy, achieving at least partial remission in most patients by 18 months. In steroid-dependent nephrotic syndrome, rituximab effectively prevents relapses, particularly in children, though benefits are transient. For lupus nephritis, newer approaches including obinutuzumab and chimeric antigen receptor (CAR) T cell therapy have shown promising results, with CAR T cells introducing the possibility of being free of disease activity and treatment for a prolonged time. In antineutrophil cytoplasmic antibody-associated glomerulonephritis, rituximab has proven effective for both induction and maintenance t...