[KDIGO-Update: Treatment of ANCA vasculitis].
The 2024 KDIGO update for ANCA-associated vasculitis with kidney involvement centres on cutting glucocorticoid exposure, and now positions the C5a receptor blocker avacopan as an alternative to glucocorticoids in remission induction.
Background
ANCA-associated vasculitis (AAV) is a life-threatening systemic autoimmune disease in which a break of tolerance against either proteinase 3 or myeloperoxidase is central to disease aetiology. Innate and adaptive immune cells cooperate to produce an inflammatory necrotising small-vessel vasculitis that can affect every organ and frequently involves the kidneys. Necrotising crescentic glomerulonephritis is associated with worse patient outcome. Anti-inflammatory and immunosuppressive treatments effectively induce remission of acute vasculitis but carry treatment-related morbidity and mortality.
What the update changes
In 2024 KDIGO published an update of its Clinical Practice Guideline for the management of AAV patients with kidney manifestation. A major aspect of the update is the consistent reduction of glucocorticoid exposure in order to diminish glucocorticoid toxicity. The C5a receptor blocker avacopan allows a significant reduction in cumulative glucocorticoids during AAV induction treatment while increasing sustained remission and improving glomerular filtration rate, and it is therefore now considered in the guideline as an alternative to glucocorticoids.
Clinical implications
Beyond glucocorticoid minimisation, the KDIGO experts address the use of cyclophosphamide and rituximab, or combinations of the two, for inducing remission in patients with severe kidney involvement, and provide considerations for the use of plasma exchange. For nephrologists managing AAV with kidney disease, the practical shift is that a glucocorticoid-sparing induction strategy built around avacopan is now an explicitly guideline-supported option rather than an off-guideline choice.
Category
KDIGO
Source
Dtsch Med Wochenschr
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.