CARI Guidelines Commentary on the KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases

Bhadran Bose^{1

2}, Simon A Carter^{1

3

4}, Mia E Abdy^{5

6}, Nicole Scholes-Robertson^{5

6}, Ieyesha Roberts^{5

6}, Tze Liang Goh⁷, Vincent Lee^{6

8}, Emily See^{9

10}, Helen Coolican¹¹, Vanessa Cullen¹¹, Min Jun^{12

13}, Rathika Krishnasamy^{1

14}, Kelly Lambert¹⁵, Jonathan Craig¹⁶, Casey Light^{17

18}, Thu Nguyen⁷, Carla Scuderi^{19

20}, David J Tunnicliffe^{5

6}, Andrea K Viecelli^{1

21}

Affiliations

¹ Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
² Department of Nephrology, Nepean Hospital, Kingswood, Australia.
³ Department of Nephrology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
⁴ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁵ Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
⁷ Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.
⁸ Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia.
¹¹ Consumer Partner, Sydney, New South Wales, Australia.
¹² Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹³ The George Institute for Global Health, Sydney, New South Wales, Australia.
¹⁴ Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
¹⁵ School of Medical, Indigenous and Health Sciences, The University of Wollongong, Wollongong, New South Wales, Australia.
¹⁶ College of Medicine and Health, Flinders University, Adelaide, South Australia, Australia.
¹⁷ School of Nursing, Curtin University, Perth, Western Australia, Australia.
¹⁸ Armadale Hospital, Mount Nasura, Western Australia, Australia.
¹⁹ Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.
²⁰ School of Pharmacy, University of Queensland, Brisbane, Australia.
²¹ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.

PMID: 40955731
PMCID: PMC12439324
DOI: 10.1111/nep.70119

CARI Guidelines Commentary on the KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases

Bhadran Bose et al. Nephrology (Carlton). 2025 Sep.

. 2025 Sep;30(9):e70119.

doi: 10.1111/nep.70119.

Authors

Affiliations

¹ Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
² Department of Nephrology, Nepean Hospital, Kingswood, Australia.
³ Department of Nephrology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
⁴ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁵ Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
⁷ Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.
⁸ Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia.
¹¹ Consumer Partner, Sydney, New South Wales, Australia.
¹² Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹³ The George Institute for Global Health, Sydney, New South Wales, Australia.
¹⁴ Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
¹⁵ School of Medical, Indigenous and Health Sciences, The University of Wollongong, Wollongong, New South Wales, Australia.
¹⁶ College of Medicine and Health, Flinders University, Adelaide, South Australia, Australia.
¹⁷ School of Nursing, Curtin University, Perth, Western Australia, Australia.
¹⁸ Armadale Hospital, Mount Nasura, Western Australia, Australia.
¹⁹ Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.
²⁰ School of Pharmacy, University of Queensland, Brisbane, Australia.
²¹ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.

PMID: 40955731
PMCID: PMC12439324
DOI: 10.1111/nep.70119

Abstract

Aim: The KDIGO 2021 Glomerular Disease Guidelines provide updated recommendations on the management of glomerular diseases (GD), with substantial advances made in diagnosis, treatment, and improvement of outcomes for people with GD.

Methods: The Caring for Australians and New Zealanders with kidney Impairment (CARI) Guidelines commentary contextualises the updated guidelines for the Australian and New Zealand setting.

Results: Kidney biopsy remains central to diagnosis, with validated scoring systems available. However, genetic testing for suspected monogenic kidney disease is now accessible in Australia, enabling earlier diagnosis and management, particularly in situations where a kidney biopsy is considered high risk or contraindicated. The guideline emphasises timed urine collections for protein excretion over spot tests and we suggest the use of the CKiD u25 eGFR equation for people under 25. For IgA nephropathy (IgAN) and IgA vasculitis (IgAV), emerging therapies such as targeted-release budesonide and sparsentan demonstrate promise but await approval and public subsidy in our region. For membranous nephropathy, the guideline highlights the differences in adult and paediatric management. In nephrotic syndrome, tacrolimus is used as first-line therapy and rituximab as a second-line agent for steroid-dependent or frequently relapsing disease. Minimal change disease recommendations include glucocorticoid tapering after remission, while focal segmental glomerulosclerosis incorporates genetic classifications and advocates for next-generation sequencing.

Conclusion: Our commentary underscores the need for increased participation in clinical trials to validate regional applicability and improve long-term outcomes for people with GD in Australia and New Zealand. Clinical trials of new medications have led to more treatment options that are awaiting approval.

Keywords: IgA nephropathy; antineutrophil cytoplasmic antibody (ANCA); glomerulonephritis (GN); guidelines; lupus nephritis; nephrotic syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**FIGURE 1**
Pathophysiology of membranoproliferative glomerulonephritis.

**FIGURE 2**
Maintenance therapy for patients with ANCA‐associated vasculitis.

**FIGURE 3**
Management of patient with relapsing and refractory ANCA‐associated vasculitis.

See this image and copyright information in PMC

References

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1. Bajema I. M., Wilhelmus S., Alpers C. E., et al., “Revision of the International Society of Nephrology/Renal Pathology Society Classification for Lupus Nephritis: Clarification of Definitions, and Modified National Institutes of Health Activity and Chronicity Indices,” Kidney International 93, no. 4 (2018): 789–796. - PubMed

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CARI Guidelines Commentary on the KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases

Affiliations

CARI Guidelines Commentary on the KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous