Possibilities of using biological therapy in patients with glomerular disease

Recently, there have been increasing numbers of patients with kidney disease who fail to respond to standard treatment or relapse following

its termination. The use of biological drugs, products of protein nature most commonly prepared by fusion of proteins of various origin (animal

or human antibodies), is a possible solution for these patients. Intravenous human immunoglobulins that, by binding autoantibodies, result

in the control of the immune process can be considered to be the earliest form of biological therapy. They are particularly used in patients

with a severe course of SLE or ANCA-associated vasculitides. Currently, a wide range of monoclonal antibodies are available, both chimeric

and fully human ones, that are targeted directly at key antigens or cytokines. Most frequently, rituximab is administered that is indicated in

patients with a relapsing or refractory course of ANCA-associated vasculitides or in those with an indolent course of lupus nephritis. Small

studies have reported a positive effect of rituximab even in patients with relapses of membranous glomerulonephritis or in those with

idiopathic nephrotic syndrome. TNF-alpha inhibitors (infliximab, etanercept, and adalimumab) have also been used in patients with ANCAassociated

vasculitides with varying success. More recently, alemtuzumab has shown promise in this group of patients. Belimumab shows

positive results with a reduction in the SLEDAI score in patients with SLE, particularly in terms of the activity of extrarenal manifestations

of the disease. Also promising appears the use of eculizumab in diseases where alternative complement pathway activation plays a key

role in the pathogenesis, as is the case with haemolytic-uraemic syndrome or in some forms of membranoproliferative glomerulonephritis.

Keywords: ANCA-associated vasculitides, SLE, monoclonal antibodies, rituximab