New Therapies for Primary Membranous Nephropathy
Article Sidebar
Main Article Content
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome. Primary MN accounts for 70-85% of MN in adults. Clinical manifestations include insidious onset of swelling, heavy proteinuria with bland urinary sediments, normal renal function and blood pressure. Primary MN is an immunologically mediated disease characterized by the deposition of immune complexes in the subepithelial space with the formation of immune complexes with epitopes on podocyte membranes. Seventy-five to eighty percent of the patients with primary MN have autoantibody to M-type phospholipase A2 receptor (PLA2R). The measurement of anti-PLA2R antibody has been widely accepted in the diagnosis and prognostic prediction due to its high sensitivity and specificity. Initial therapy includes supportive care. Immunosuppressive drugs are recommended in patients with persistent nephrotic syndrome and progressive decline in kidney function. Current evidence suggests the benefit of selective B-cell depletion or rituximab in inducing remission in primary MN.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This article is published under CC BY-NC-ND 4.0 license, which allows for non-commercial reuse of the published paper as long as the published paper is fully attributed. Anyone can share (copy and redistribute) the material in any medium or format without having to ask permission from the author or the Nephrology Society of Thailand.
References
Parichatikanond P, Chawanasuntorapoj R, Shayakul C, Cheunsuchon B, Vasuvattakul S, Vareesangthip K, et al. An analysis of 3,555 cases of renal biopsy in Thailand. J Med Assoc Thai. 2006;89 suppl 2:106-11.
Chawanasuntorapoj R, Chuensuchon B, Kitiyakara C, Thai Glomerular Disease Collaborative Network. Improvement of Clinical Outcome in Kidney Diseases via On-line Thai Glomerular Disease Registry: 2nd Year. 2017.
Xu X, Wang G, Chen N, Lu T, Nie S, Xu G, et al. Long-Term Exposure to Air Pollution and Increased Risk of Membranous Nephropathy in China. J Am Soc Nephrol. 2016;27(12):3739-46.
Satirapoj B. Clinical features and renal pathology of glomerular disease in Phramongkutklao Hospital. Royal Thai Army Medical Journal. 2010;63(2):53-64.
Cattran DC, Brenchley PE. Membranous nephropathy: integrating basic science into improved clinical management. Kidney Int. 2017;91(3):566-74.
Ronco P, Debiec H. Pathogenesis of membranous nephropathy: recent advances and future challenges. Nat Rev Nephrol. 2012;8(4):203-13.
Du Y, Li J, He F, Lv Y, Liu W, Wu P, et al. The diagnosis accuracy of PLA2R-AB in the diagnosis of idiopathic membranous nephropathy: a meta-analysis. PLoS One. 2014;9(8):e104936.
Wiech T, Stahl RAK, Hoxha E. Diagnostic role of renal biopsy in PLA2R1-antibody-positive patients with nephrotic syndrome. Mod Pathol. 2019;32(9):1320-8.
Tampoia M, Migliucci F, Villani C, Abbracciavento L, Rossini M, Fumarulo R, et al. Definition of a new cut-off for the anti-phospholipase A2 receptor (PLA2R) autoantibody immunoassay in patients affected by idiopathic membranous nephropathy. J Nephrol. 2018;31(6):899-905.
KDIGO Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S128-39.
Tomas NM, Beck LH, Jr., Meyer-Schwesinger C, Seitz-Polski B, Ma H, Zahner G, et al. Thrombospondin type-1 domaincontaining 7A in idiopathic mem-branous nephropathy. N Engl J Med. 2014;371(24):2277-87.
Sethi S, Debiec H, Madden B, Charlesworth MC, Morelle J, Gross L, et al. Neural epidermal growth factor-like 1 protein (NELL-1) associated membranous nephropathy. Kidney Int. 2020;97(1):163-74.
Sethi S, Debiec H, Madden B, Vivarelli M, Charlesworth MC, Ravindran A, et al. Semaphorin 3B-associated membranous nephropathy is a distinct type of disease predominantly present in pediatric patients. Kidney Int. 2020;98(5):1253-64.
Seitz-Polski B, Debiec H, Rousseau A, Dahan K, Zaghrini C, Payre C, et al. Phospholipase A2 Receptor 1 Epitope Spreading at Baseline Predicts Reduced Likelihood of Remission of Membranous Nephropathy. J Am Soc Nephrol. 2018;29(2):401-8.
Pei Y, Cattran D, Greenwood C. Predicting chronic renal insufficiency in idiopathic membranous glomerulonephritis. Kidney Int. 1992;42(4):960-6.
Shiiki H, Saito T, Nishitani Y, Mitarai T, Yorioka N, Yoshimura A, et al. Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan. Kidney Int. 2004;65(4):1400-7.
Ponticelli C, Zucchelli P, Imbasciati E, Cagnolo L, Pozzi C, Passerini P, et al. Controlled trial of methylprednisolone and chlorambucil in idiopathic membranous nephropathy. N Engl J Med. 1984;310:946-50.
Ponticelli C, Zucchelli P, Passerini P, Cesana B, Locatelli F, Pasquali S, et al. A 10-year follow-up of a randomized study with methylprednisolone and chlorambucil in membranous nephropathy. Kidney Int. 1995;48(5):1600-4.
Ponticelli C, Altieri P, Passerini P, Roccatello D, Cesana B, Melis P, et al. A randomized study comparing methylprednisolone plus chlorambucil versus methylprednisolone plus cyclophosphamide in idiopathic membranous nephropathy. J Am Soc Nephrol. 1998;9:444-50.
Branten AJ, Reichert LJ, Koene RA, Wetzels JF. Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency. Q J Med. 1998;91:359-66.
Howman A, Chapman TL, Langdon MM, Ferguson C, Adu D, Feehally J, et al. Immunosuppression for progressive membranous nephropathy: a UK randomised controlled trial. Lancet. 2013;381(9868):744-51.
Chen M, Li H, L XY, Lu FM, Ni ZH, Xu FF, et al. Tacrolimus Combined With Corticosteroids in Treatmentof Nephrotic Idiopathic Membranous Nephropathy: A Multicenter Randomized Controlled Trial. Am J Med Sci. 2010;339(3):233–8.
Naumovic R, Jovanovic D, Pavlovic S, Stosovic M, Marinkovic J, Basta-Jovanovic G. Cyclosporine versus azathioprine therapy in high-risk idiopathic membranous nephropathy patients: A 3-year prospective study. Biomed Pharmacother. 2011;65(2):105-10.
Qiu TT, Zhang C, Zhao HW, Zhou JW. Calcineurin inhibitors versus cyclophosphamide for idiopathic membranous nephropathy: A systematic review and meta-analysis of 21 clinical trials. Autoimmun Rev. 2017;16(2):136-45.
Dahan K, Debiec H, Plaisier E, Cachanado M, Rousseau A, Wakselman L, et al. Rituximab for Severe Membranous Nephropathy: A 6-Month Trial with Extended Follow-Up. J Am Soc Nephrol. 2017;28(1):348-58.
Fervenza FC, Appel GB, Barbour SJ, Rovin BH, Lafayette RA, Aslam N, et al. Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy. N Engl J Med. 2019;381(1):36-46.
Fernandez-Juarez G, Rojas-Rivera J, Logt AV, Justino J, Sevillano A, Caravaca-Fontan F, et al. The STARMEN trial indicates that alternating treatment with corticosteroids and cyclophosphamide is superior to sequential treatment with tacrolimus and rituximab in primary membranous nephropathy. Kidney Int. 2021;99(4):986-98.
Lindskog A, Ebefors K, Johansson ME, Stefansson B, Granqvist A, Arnadottir M, et al. Melanocortin 1 receptor agonists reduce proteinuria. J Am Soc Nephrol. 2010;21(8):1290-8.
Chan TM, Lin AW, Tang SC, Qian JQ, Lam MF, Ho YW, et al. Prospective controlled study on mycophenolate mofetil and prednisolone in the treatment of membranous nephropathy with nephrotic syndrome. Nephrology (Carlton). 2007;12(6):576-81.
Nikolopoulou A, Condon M, Turner-Stokes T, Cook HT, Duncan N, Galliford JW, et al. Mycophenolate mofetil and tacrolimus versus tacrolimus alone for the treatment of idiopathic membranous glomerulonephritis: a randomised controlled trial. BMCNephrol. 2019;20(1):352.
Sethi S, Kumar S, Lim K, Jordan SC. Obinutuzumab is Effective for the Treatment of Refractory Membranous Nephropathy. Kidney Int Rep. 2020;5(9):1515-8.