Antibody-mediated GN including lupus nephritis, ANCA-associated GN, anti-GBM disease, and cryoglobulinemia is treated with which regimen?

• A. Steroids, cyclophosphamide, and mycophenolate
• B. Rituximab monotherapy
• C. Calcineurin inhibitors alone
• D. Antibiotics

Answer: (A)

The main idea is that immune-mediated GN from these diseases needs strong immunosuppression to stop the antibody-driven damage to the kidneys. High-dose corticosteroids quell inflammation, while a cytotoxic immunosuppressant like cyclophosphamide broadly suppresses B and T cell activity to prevent ongoing autoantibody production and glomerular injury. Mycophenolate mofetil serves as another effective immunosuppressant option, especially in lupus nephritis, and is used in place of or alongside cyclophosphamide in various regimens. Together, steroids with cyclophosphamide, and sometimes mycophenolate, target the underlying autoimmune process across lupus nephritis, ANCA-associated GN, anti-GBM disease, and cryoglobulinemic GN.

Rituximab monotherapy often isn’t sufficient for these severe forms of GN, calcineurin inhibitors alone don’t provide the full immunosuppressive effect needed, and antibiotics do not address the immune-mediated injury.