TY - JOUR
T1 - Management of antineutrophil cytoplasmic antibody–associated vasculitis with glomerulonephritis as proposed by the ACR 2021, EULAR 2022 and KDIGO 2021 guidelines/recommendations
AU - on behalf of the ERA Immunonephrology Working Group (IWG)
AU - Moura, Marta Casal
AU - Gauckler, Philipp
AU - Anders, Hans Joachim
AU - Bruchfeld, Annette
AU - Fernandez-Juarez, Gema M.
AU - Floege, Jürgen
AU - Frangou, Eleni
AU - Goumenos, Dimitrios
AU - Segelmark, Marten
AU - Turkmen, Kultigin
AU - van Kooten, Cees
AU - Tesar, Vladimir
AU - Geetha, Duvuru
AU - Fervenza, Fernando C.
AU - Jayne, David R.W.
AU - Stevens, Kate I.
AU - Kronbichler, Andreas
N1 - Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Updated guidelines on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) were released in 2021 by the American College of Rheumatology jointly with the Vasculitis Foundation and, subsequently, in 2022 by the European Alliance of Associations for Rheumatology. In addition, in 2021, the Kidney Disease: Improving Global Outcomes had released updated recommendations on the treatment of AAV with glomerulonephritis (AAV-GN). Kidney involvement is particularly relevant in microscopic polyangiitis and granulomatosis with polyangiitis, but is less frequent in eosinophilic granulomatosis with polyangiitis. The management of AAV-GN has been a focus for drug development and change over the past 10 years. Avoidance of progression to end-stage kidney disease (ESKD) or kidney failure is one of the main unmet needs in the management of AAV, with ESKD having a major impact on morbidity, health costs and mortality risk. Relevant changes in AAV-GN management are related to remission-induction treatment of patients with severe kidney disease, the use of glucocorticoids and avacopan, and remission-maintenance treatment. All the documents provide guidance in accordance with the evidence-based standard of care available at the time of their release. With our work we aim to (i) show the progress made and identify the differences between guidelines and recommendations, (ii) discuss the supporting rationale for those, and (iii) identify gaps in knowledge that could benefit from additional research and should be revised in subsequent updates.
AB - Updated guidelines on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) were released in 2021 by the American College of Rheumatology jointly with the Vasculitis Foundation and, subsequently, in 2022 by the European Alliance of Associations for Rheumatology. In addition, in 2021, the Kidney Disease: Improving Global Outcomes had released updated recommendations on the treatment of AAV with glomerulonephritis (AAV-GN). Kidney involvement is particularly relevant in microscopic polyangiitis and granulomatosis with polyangiitis, but is less frequent in eosinophilic granulomatosis with polyangiitis. The management of AAV-GN has been a focus for drug development and change over the past 10 years. Avoidance of progression to end-stage kidney disease (ESKD) or kidney failure is one of the main unmet needs in the management of AAV, with ESKD having a major impact on morbidity, health costs and mortality risk. Relevant changes in AAV-GN management are related to remission-induction treatment of patients with severe kidney disease, the use of glucocorticoids and avacopan, and remission-maintenance treatment. All the documents provide guidance in accordance with the evidence-based standard of care available at the time of their release. With our work we aim to (i) show the progress made and identify the differences between guidelines and recommendations, (ii) discuss the supporting rationale for those, and (iii) identify gaps in knowledge that could benefit from additional research and should be revised in subsequent updates.
KW - ANCA-associated vasculitis
KW - glomerulonephritis
KW - granulomatosis with polyangiitis
KW - guidelines
KW - microscopic polyangiitis
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U2 - 10.1093/ndt/gfad090
DO - 10.1093/ndt/gfad090
M3 - Review article
C2 - 37164940
AN - SCOPUS:85171743428
SN - 0931-0509
VL - 38
SP - 2637
EP - 2651
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 11
ER -