Targeting B Cells in Immune-Mediated Kidney Diseases: KDIGO Controversies Conference Conclusions

KDIGO convened a Controversies Conference in June 2025 to evaluate B cell–targeted strategies for immune-mediated glomerular diseases and to delineate evidence gaps and research needs for implementing these therapies. Available data indicate substantial heterogeneity in the availability, effectiveness, and safety of B cell–targeted interventions across different glomerular conditions.

The conference highlighted that results with B cell depletion or modulation are disease-specific rather than universally applicable, with varying implications for clinical outcomes and risk profiles. In IgA nephropathy, rituximab (anti-CD20) has demonstrated limited efficacy based on current evidence.

By contrast, approaches targeting B cell–related pathways beyond CD20, including inhibitors of BAFF (B cell activating factor) and APRIL (a proliferation inducing ligand), as well as anti-CD38 antibodies, have been associated with reductions in proteinuria and a slower decline in estimated glomerular filtration rate in some studies. However, the overall certainty of these effects remains uncertain due to limited data, heterogeneity of study designs, and incomplete long-term safety information.