Therapies for Membranous Nephropathy: A Tale From the Old and New Millennia

Overview

Journal Front Immunol

Specialty Allergy & Immunology

Date 2022 Mar 18

PMID 35300332

Authors

Francesco Scolari

Federico Alberici

Federica Mescia

Elisa Delbarba

Hernando Trujillo

Manuel Praga

Claudio Ponticelli

Affiliations

Soon will be listed here.

Abstract

Primary Membranous Nephropathy (PMN) is the most frequent cause of nephrotic syndrome in adults. If untreated, PMN can lead to end-stage renal disease; moreover, affected patients are at increased risk of complications typical of nephrotic syndrome such as fluid overload, deep vein thrombosis and infection. The association of PMN with and the identification in around 70% of cases of circulating autoantibodies, mainly directed towards the phospholipase A2 receptor, supports the autoimmune nature of the disease. In patients not achieving spontaneous remission or in the ones with deteriorating kidney function and severe nephrotic syndrome, immunosuppression is required to increase the chances of achieving remission. The aim of this review is to discuss the evidence base for the different immunosuppressive regimens used for PMN in studies published so far; the manuscript also includes a section where the authors propose, based upon current evidence, their recommendations regarding immunosuppression in the disease, while highlighting the still significant knowledge gaps and uncertainties.

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