Med. praxi. 2012;9(5):214-220

Biological therapy in nephrology

doc.MUDr.Romana Ryšavá, CSc.

Klinika nefrologie 1. LF UK a VFN, Praha

Biological therapy is becoming increasingly common in everyday practice. In nephrological disease there are more patients, due to

improved survival, who fail to respond to standard treatment or relapse following its termination. Biological drugs are substances of

protein nature that are targeted against a target antigen or cytokine, thereby becoming more sparing of the body. This does not imply,

however, that the use of these agents cannot be associated with adverse events. Among those, used particularly in the past, are intravenous

human immunoglobulins that, by binding autoantibodies, result in the control of the immune process. Their use is relatively

universal in a number of autoimmune diseases. Currently, a wide range of monoclonal antibodies are available, both chimeric and fully

human ones. 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 ANCA-associated vasculitides with a varying success. More

recently, alemtuzumab has shown promise in this group of patients. Belimumab shows positive results in patients with systemic lupus

erythematosus, particularly in the presence 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: biological therapy, nephrological disease

Published: May 31, 2012  Show citation