Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases

Brad H Rovin; Sharon G Adler; Jonathan Barratt; Frank Bridoux; Kelly A Burdge; Tak Mao Chan; H Terence Cook; Fernando C Fervenza; Keisha L Gibson; Richard J Glassock; David R W Jayne; Vivekanand Jha; Adrian Liew; Zhi-Hong Liu; Juan M Mejía-Vilet; Carla M Nester; Jai Radhakrishnan; Elizabeth M Rave; Heather N Reich; Pierre Ronco; Jan-Stephan F Sanders; Sanjeev Sethi; Yusuke Suzuki; Sydney C W Tang; Vladimír Tesar; Marina Vivarelli; Jack F M Wetzels; Lyubov Lytvyn; Jonathan C Craig; David J Tunnicliffe; Martin Howell; Marcello A Tonelli; Michael Cheung; Amy Earley; Jürgen Floege

doi:10.1016/j.kint.2021.05.015

Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases

Kidney Int. 2021 Oct;100(4):753-779. doi: 10.1016/j.kint.2021.05.015.

Authors

Brad H Rovin¹, Sharon G Adler², Jonathan Barratt³, Frank Bridoux⁴, Kelly A Burdge⁵, Tak Mao Chan⁶, H Terence Cook⁷, Fernando C Fervenza⁸, Keisha L Gibson⁹, Richard J Glassock¹⁰, David R W Jayne¹¹, Vivekanand Jha¹², Adrian Liew¹³, Zhi-Hong Liu¹⁴, Juan M Mejía-Vilet¹⁵, Carla M Nester¹⁶, Jai Radhakrishnan¹⁷, Elizabeth M Rave¹⁸, Heather N Reich¹⁹, Pierre Ronco²⁰, Jan-Stephan F Sanders²¹, Sanjeev Sethi²², Yusuke Suzuki²³, Sydney C W Tang⁶, Vladimír Tesar²⁴, Marina Vivarelli²⁵, Jack F M Wetzels²⁶, Lyubov Lytvyn²⁷, Jonathan C Craig²⁸, David J Tunnicliffe²⁹, Martin Howell²⁹, Marcello A Tonelli³⁰, Michael Cheung³¹, Amy Earley³¹, Jürgen Floege³²

Affiliations

¹ Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA. Electronic address: [email protected].
² Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute, Los Angeles, California, USA.
³ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁴ Department of Nephrology and Renal Transplantation, CIC INSERM 1402, Centre Hospitalier Universitaire, University Hospital Poitiers, Poitiers, France.
⁵ Division of Nephrology, Mass General Brigham-Salem Hospital, Salem, Massachusetts, USA.
⁶ Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong, China.
⁷ Renal and Transplant Centre, Imperial College London, London, UK.
⁸ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
⁹ University of North Carolina Kidney Center at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰ Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
¹¹ Division of Experimental Medicine & Immunotherapeutics, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
¹² The George Institute for Global Health, New Delhi, India; School of Public Health, Imperial College London, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
¹³ The Kidney and Transplant Practice, Mount Elizabeth Novena Hospital, Singapore.
¹⁴ Nanjing University School of Medicine, Nanjing, China.
¹⁵ Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico.
¹⁶ Molecular Otolaryngology & Renal Research Laboratories, University of Iowa, Iowa City, Iowa, USA.
¹⁷ Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
¹⁸ Ohio Kidney Associates, Columbus, Ohio, USA.
¹⁹ Divsion of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
²⁰ Sorbonne University, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1155, Paris, France; Le Mans Hospital, Le Mans, France.
²¹ Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, The Netherlands.
²² Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
²³ Department of Nephrology, Juntendo University, Tokyo, Japan.
²⁴ Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
²⁵ Department of Pediatric Subspecialties, Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
²⁶ Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁷ MAGIC Evidence Ecosystem Foundation, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
²⁸ College of Medicine and Public Health, Flinders University, Adelaide, Australia; Cochrane Kidney and Transplant, Sydney, New South Wales, Australia.
²⁹ Cochrane Kidney and Transplant, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
³⁰ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³¹ KDIGO, Brussels, Belgium.
³² Division of Nephrology, University Hospital, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany. Electronic address: [email protected].

PMID: 34556300
DOI: 10.1016/j.kint.2021.05.015

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Glomerular Diseases is an update to the KDIGO 2012 guideline. The aim is to assist clinicians caring for individuals with glomerulonephritis (GN), both adults and children. The scope includes various glomerular diseases, including IgA nephropathy and IgA vasculitis, membranous nephropathy, nephrotic syndrome, minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), infection-related GN, antineutrophil cytoplasmic antibody (ANCA) vasculitis, lupus nephritis, and anti-glomerular basement membrane antibody GN. In addition, this guideline will be the first to address the subtype of complement-mediated diseases. Each chapter follows the same format providing guidance related to diagnosis, prognosis, treatment, and special situations. The goal of the guideline is to generate a useful resource for clinicians and patients by providing actionable recommendations based on evidence syntheses, with useful infographics incorporating views from experts in the field. Another aim is to propose research recommendations for areas where there are gaps in knowledge. The guideline targets a broad global audience of clinicians treating GN while being mindful of implications for policy and cost. Development of this guideline update followed an explicit process whereby treatment approaches and guideline recommendations are based on systematic reviews of relevant studies, and appraisal of the quality of the evidence and the strength of recommendations followed the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. Limitations of the evidence are discussed, with areas of future research also presented.

Keywords: AAV; ANCA; C3; FSGS; IgA nephropathy; IgA vasculitis; KDIGO; MPGN; anti-GBM; complement; evidence-based; glomerular diseases; glomerulonephritis; guideline; infection-related glomerulonephritis; lupus nephritis; membranous nephropathy; minimal change disease; nephrotic syndrome; systematic review.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Glomerulonephritis* / diagnosis
Glomerulonephritis* / therapy
Glomerulonephritis, IGA* / diagnosis
Glomerulonephritis, IGA* / therapy
Glomerulonephritis, Membranous* / diagnosis
Glomerulonephritis, Membranous* / drug therapy
Humans
Kidney
Nephrosis, Lipoid*