Drug repurposing in glomerular disease can deliver opportunities for steroid-free regimens, enable personalized multi-target options for resistant or relapsing disease and enhance treatment options for understudied populations (for example, children) and in resource-limited settings. Identification of drug-repurposing candidates can be data driven, which utilizes existing data on disease pathobiology, drug features and clinical outcomes, or experimental, which involves high-throughput drug screens. Information from databases of approved drugs, clinical trials and PubMed registries suggests that at least 96 drugs on the market cover 49 targets with immunosuppressive potential that could be candidates for drug repurposing in glomerular disease. Furthermore, evidence to support drug repurposing is available for 191 immune drug target–glomerular disease pairs. Non-immunological drug repurposing includes strategies to reduce haemodynamic overload, podocyte injury and kidney fibrosis. Recommended strategies to expand drug-repurposing capacity in glomerular disease include enriching drug databases with glomeruli-specific information, enhancing the accessibility of primary clinical trial data, biomarker discovery to improve participant selection into clinical trials and improve surrogate outcomes and initiatives to reduce patent, regulatory and organizational hurdles.

肾小球疾病的药物再利用可以为无类固醇治疗方案提供机会，为耐药或复发性疾病提供个性化的多靶点选择，并为未充分研究的人群（例如儿童）和资源有限的环境提供更多的治疗选择。药物再利用候选药物的识别可以是数据驱动的，利用疾病病理学、药物特征和临床结果的现有数据，也可以是实验的，涉及高通量药物筛选。来自已批准药物、临床试验和 PubMed 注册数据库的信息表明，市场上至少有 96 种药物涵盖了 49 个具有免疫抑制潜力的靶点，这些靶点可能是肾小球疾病药物再利用的候选药物。此外，有 191 个免疫药物靶点 - 肾小球疾病对支持药物再利用的证据。非免疫药物再利用包括减少血流动力学超负荷、足细胞损伤和肾纤维化的策略。扩大肾小球疾病药物再利用能力的推荐策略包括用肾小球特异性信息丰富药物数据库、增强主要临床试验数据的可访问性、生物标志物发现以改善临床试验参与者的选择并改善替代结果以及减少专利、监管的举措和组织障碍。