Treatment of Idiopathic Membranous Nephropathy

Ehrenreich, Theodore; Porush, Jerome G.; Churg, Jacob; Garfinkel, Lawrence; Glabman, Sheldon; Goldstein, M.; Grishman, Edith; Yunis, Stuart L.

doi:10.1056/nejm197609302951401

Cited by 149 publications

(72 citation statements)

References 12 publications

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“…All MN biopsies were staged (1 through 4) according to the Ehrenreich and Churg system [20]. On light microscopy, the degree of tubular atrophy/interstitial fibrosis, interstitial inflammation, and vascular disease were graded as follows: grade 0 or absent (0%), grade 1 or minimal (1–10%), grade 2 or mild (11–25%), grade 3 or moderate (26–50%), or grade 4 or severe (51–100%).…”

Section: Methodsmentioning

confidence: 99%

Idiopathic Membranous Nephropathy: Clinical and Histologic Prognostic Features and Treatment Patterns over Time at a Tertiary Referral Center

Sprangers¹,

Bomback²,

Cohen³

et al. 2012

Am J Nephrol

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Background: Idiopathic membranous nephropathy (i-MN) is a leading cause of nephrotic syndrome in adults and results in end-stage renal disease in approximately one third of patients. There are few large, long-term US studies evaluating clinical and histologic prognostic factors in i-MN. Methods: We describe 132 patients with biopsy-proven i-MN who were followed for a mean period of 68 months at our tertiary referral center from 1977 to 2009, and we analyzed clinical and histologic features that predicted renal outcomes. Results: The presence of hypertension and treating physician’s decision to institute immunosuppression were negative predictors of attaining complete or partial remission. Among clinical variables, impaired renal function (eGFR <60 ml/min/1.73 m²) at time of presentation was the only variable at presentation associated with an increased risk of reaching end-stage renal disease. The use of statins and RAAS blockers were protective. The choice of corticosteroids as the initial immunosuppressive agent by referring physicians decreased over time but even in the most recent era (2000–2008) was significant (33%). Conclusion: Renal function at presentation and non-white race were the main predictors of a worse renal outcome. Corticosteroid therapy is still being adopted as first-line therapy in a significant number of patients in this era. The development of guidelines may help clarify the treatment strategies of i-MN.

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Section: Methodsmentioning

confidence: 99%

Idiopathic Membranous Nephropathy: Clinical and Histologic Prognostic Features and Treatment Patterns over Time at a Tertiary Referral Center

Sprangers¹,

Bomback²,

Cohen³

et al. 2012

Am J Nephrol

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“…Histological staging was based on histological lesion, including glomerular lesion, 15 tubulointerstitial lesion, focal glomerulosclerosis, 16 and fibrointimal lesion. Biopsy specimens were reviewed by a nephropathologist unaware of patients' clinical history, renal function, and IL-6 gene SNP (C-572G).…”

Section: Renal Biopsy Reviewmentioning

confidence: 99%

Effect ofIL-6C-572G polymorphism on idiopathic membranous nephropathy risk in a han chinese population

Chen

Huang

et al. 2010

Renal Failure

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Membranous glomerulonephritis (MGN) is viewed as an immune-mediated glomerular disease, with immunologic expression occurring in genetically susceptible persons. The cytokine interleukin-6 (IL-6) gene polymorphism is known to impair intracellular signaling pathways following adaptive immune response. Our study gauged the effects of IL-6 C-572G (rs1800796) single nucleotide polymorphism (SNP) on MGN among Taiwan's Han Chinese population, as analyzed in 265 controls and 106 MGN patients. Genotyping for IL-6 C-572G SNP was performed by restriction fragment length polymorphism assay. Data showed stark differences in genotype and allele frequency distributions at IL-6 C-572G SNP between MGN patients and controls (p = 1.6E-04 and 1.7E-04, respectively). People with C allele or with CC genotype at IL-6 C-572G SNP showed higher risk of MGN (odds ratio = 2.42 and 2.71, respectively; 95% confidence interval = 1.51-3.87 and 1.60-4.60, respectively). These point to IL-6 C-572G polymorphism as the underlying cause of MGN; polymorphism merits further investigation.

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“…The histologic sections were subsequently reviewed by an external renal pathologist who was blinded to the purpose of this study. Glomerular stages were classified according to the system of Ehrenreich et al 26 : in stage I, the glomeruli appear almost normal on light microscopy but have small epimembranous deposits on electron microscopy; in stage II, diffuse, uniform thickening of the capillary walls with basement membrane spiking is observed; in stage III, diffuse, irregular thickening of the capillary walls due to the formation of new immune deposits incorporated into the basement membrane is observed; in stage IV, the capillary walls are markedly thickened and contain fading immune deposits. Mesangial glomerular sclerosis, arteriosclerosis, and interstitial fibrosis with tubular atrophy were classified as present or absent.…”

Section: Renal Histologymentioning

confidence: 99%

Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria

Matsumoto¹,

Shimada²,

Nojima³

et al. 2013

Renal Failure

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Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria, Renal Failure, 35:7,[936][937][938][939][940][941] Background: Idiopathic membranous nephropathy (IMN) patients with persistent high-grade proteinuria are at the highest risk for developing end-stage renal failure. We previously reported the effects of treatment with mizoribine followed by low-dose prednisone treatment in 4 IMN patients. The purpose of the present study was to further assess the effects of this combined treatment in a larger study group. Method: Thirteen patients with IMN and nephroticrange proteinuria received combined treatment. Mizoribine was initiated at a dose of 150 mg/ day, and 2-3 months later, 20 mg/day prednisone was added to the mizoribine regimen. The dosage of prednisone and/or mizoribine was tapered according to the urinary proteinto-creatinine ratio (P/C). We evaluated patient responses for up to 12 months after the initiation of combination therapy. Results: Before treatment, patient urinary P/C ranged from 3.7 to 15.9 g/g. Although these values did not decrease during mizoribine monotherapy, all patients showed dramatic P/C decreases over the course of combination therapy. At 3, 6, and 12 months after combination therapy, 15%, 31%, and 62% of patients attained complete remission, respectively, and all patients were in partial or complete remission 6 months after combination therapy. No notable side effects were observed. Conclusion: The addition of prednisone after mizoribine monotherapy can be beneficial for all IMN patients with nephrotic-range proteinuria syndrome. The risks associated with immunotherapy can be decreased by initially prescribing mizoribine alone, which might act as a base for establishing therapy, followed by low-dose prednisone treatment.

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Treatment of Idiopathic Membranous Nephropathy

Cited by 149 publications

References 12 publications

Idiopathic Membranous Nephropathy: Clinical and Histologic Prognostic Features and Treatment Patterns over Time at a Tertiary Referral Center

Idiopathic Membranous Nephropathy: Clinical and Histologic Prognostic Features and Treatment Patterns over Time at a Tertiary Referral Center

Effect ofIL-6C-572G polymorphism on idiopathic membranous nephropathy risk in a han chinese population

Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria

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