Glomerular diseases: Membranous nephropathy-a modern view

Claudio Ponticelli, Richard J. Glassock

Research output: Contribution to journalArticlepeer-review

Abstract

Membranous nephropathy (MN) is an autoimmune disease usually associated with a nephrotic syndrome and it may progress to ESRD in the long term. Its etiology is often unknown (idiopathicMN), whereas other cases have a recognizable etiology (secondary MN). In idiopathic MN, the glomerular lesions are mainly caused by autoantibodies against a podocyte membrane protein, the M-type of phospholipase A2 receptor 1. The natural course of idiopathic MN is quite varied with spontaneous complete or partial remissions a relatively common occurrence. Patientswith asymptomatic non-nephrotic proteinuria seldomprogress and need only conservativemanagement. Those with persistent full-blown nephrotic syndrome and those with declining renal function are candidates for specific treatment with any of several regimens. Cyclical therapy with alternating monthly intravenous and oral glucocorticoids combined with a cytotoxic agent can induce remission and preserve renal function in the long term. Cyclosporine or tacrolimus can induce remission, but relapses are frequent after the drug withdrawal. Mycophenolate mofetil monotherapy seems to be ineffective, but may be beneficial when administered together with steroids. The experience with adrenocorticotropic hormone, natural or synthetic, is limited to a few studies with short-term follow-up, but high rates of remission can be seen after prolonged treatment. A high rate of remission and good tolerance have also been reported with rituximab. Patients with moderate renal insufficiency may also benefit fromtreatment, but at a price of frequent and serious side effects.With these limitations in mind, idiopathic MN may be considered a treatable disease in many patients.

Original languageEnglish
Pages (from-to)609-616
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume9
Issue number3
DOIs
Publication statusPublished - Mar 7 2014

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation
  • Epidemiology

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