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.
Treatments that deplete or modulate B cells are in use or being investigated for several immune-mediated glomerular diseases. Kidney Disease: Improving Global Outcomes (KDIGO) convened a Controversies Conference in Panama City, Panama in June 2025 to review current evidence and identify key gaps in knowledge and research needs to effectively apply such therapies. Availability, effectiveness, and safety of B cell–targeted therapies vary substantially across glomerular diseases. In IgA nephropathy, anti-CD20 therapy (rituximab) has shown limited efficacy, although inhibitors of BAFF (B cell activating factor) and APRIL (A proliferation inducing ligand) and anti-CD38 antibodies can lead to reductions in proteinuria and reduction of decline in estimated glomerular filtration rate.