CKD therapy to improve outcomes of immune-mediated glomerular diseases.

The management of IgA nephropathy, membranous nephropathy, lupus nephritis, ANCA-associated vasculitis, C3 glomerulonephritis, autoimmune podocytopathies and other immune-mediated glomerular disorders is focused on two major treatment goals, namely preventing overall mortality and the loss of kidney function. As minimizing irreversible kidney damage best serves both goals, the management of immune-mediated kidney disorders must focus on the two central pathomechanisms of kidney function decline, i.e. controlling the underlying immune disease process, e.g. with immunotherapies, and controlling the non-immune mechanisms of chronic kidney disease (CKD) progression. Here we review the pathophysiology of these non-immune mechanisms of CKD progression and discuss non-drug and drug interventions to attenuate CKD progression in immune-mediated kidney disorders. Non-pharmacological interventions include reducing salt intake, normalizing body weight, avoiding superimposed kidney injuries, smoking cessation, and regular physical activity. Approved drug interventions include inhibitors of the renin-angiotensin-aldosterone system and of the sodium-glucose-transporter-2. Numerous additional drugs to improve CKD care are currently being tested in clinical trials. Here we discuss about how and when to use these drugs in the different clinical scenarios of immune-mediated kidney diseases.