Treatment of membranous nephropathy: Perspectives on current and future therapies

Shah, Monarch; DeLaat, Andrew; Cavanaugh, Corey

doi:10.3389/fneph.2023.1110355

Cited by 3 publications

(4 citation statements)

References 78 publications

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“…Although approximately 30% of patients with MN achieve spontaneous remission, some patients who continue to have nephrotic syndrome develop end-stage kidney disease [53]. Clinical trials have shown the effectiveness of two doses of rituximab [54,55], which was also performed in our previously reported case (Case 2 in this manuscript) [51]. Recent international guidelines recommend rituximab treatment as an induction therapy for MN [6].…”

Section: Future Perspectivesmentioning

confidence: 56%

The Prevalence, Characteristics, and Putative Mechanisms of Dual Antigen-Positive Membranous Nephropathy: The Underestimated Condition

Uchida,

Oda

2024

IJMS

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Following the discovery of podocyte phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A, various potential target antigens for membranous nephropathy (MN) have been reported one after another. MN target antigens have now been identified in a significant proportion of patients, and a new classification framework classifies patients with MN based on the detected antigen and associated disease phenotype. A serology-based approach that does not require a histological diagnosis for patients suspected of having MN has also been proposed. However, there have been cases in which dual positivity for MN antigens and/or corresponding antibodies has been shown. Importantly, some of them showed a transition of the affected patient’s immune responses to MN antigens, suggesting that serological diagnosis changes depending on the timing of the analysis. In this review, we provide detailed information on these cases and present an overview of our recent understanding of their putative mechanisms involved in these cases. Greater awareness is required to adequately recognize and develop appropriate therapeutic strategies for this condition.

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Section: Future Perspectivesmentioning

confidence: 56%

The Prevalence, Characteristics, and Putative Mechanisms of Dual Antigen-Positive Membranous Nephropathy: The Underestimated Condition

Uchida,

Oda

2024

IJMS

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“…Переважають білі чоловіки 30-50 років (з відношенням чоловіків до жінок 2 : 1). На другому, третьому і четвертому місцях -азіати, афроамериканці й латиноамериканці відповідно [2][3][4][5][6].Приблизно 80 % випадків МН класифікуються як первинна МН, яка є причиною розвитку ідіопатичного НС у понад 20 % випадків (в осіб, старших за 60 років, -понад 40 % випадків) [1,4,[7][8][9].Слід зазначити, що в дітей МГ виникає рідше, і НС, як правило, має місце в менше ніж 5 % дітей із цією патологією. І хоча сімейний МГ трапляється рідко, дітей з такою патологією слід розпитувати про сімейні випадки [2].В основі патологічного процесу при первинному МГ -утворення імунних комплексів: циркулюючі…”

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“…Близько 3 % випадків первинної МН обумовлені наявністю імунних комплексів «антиген -антитіло», які включають катіонні білки плазми (наприклад, катіонний бичачий сироватковий альбумін, який зустрічається тільки в дітей), антитромбоспондиновий домен 1-го типу 7A (THSD 7 A), анти-NEP (NEP -нейтральна ендопептидаза) (зустрічається нечасто), білок, подібний до нейроепідермального фактора росту 1 (NELL 1 ), семафорин 3b (SEMA 3b ). Інші первинні МН (від 10 до 15 %) залишаються ідіопатичними [2,4,[6][7][8][10][11][12][13][14][15]. Слід відзначити, що негативний тест на перелічені антитіла не виключає наявність МН і необхідність проведення нефробіопсії.…”

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A clinical case of primary membranous glomerulonephritis with nephrotic syndrome and resistance to standard treatment

Denova,

Krasiuk

2023

KIDNEYS

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The incidence of primary membranous glomerulonephritis is 1 case per 100,000 each year (75–80 %), with a male-to-female ratio of 2 : 1. It is the cause of idiopathic nephrotic syndrome in more than 20 % of cases (over 40 % in people aged 60 and older). The problem of membranous glomerulonephritis consists in a difficult differential diagnostic search and frequent cases of resistance to treatment. Resistance to treatment may develop in 10–20 % of patients, resulting in the end-stage renal disease requiring renal replacement therapy (dialysis or kidney transplantation). Our work presents the results of clinical observation of a patient with primary membranous glomerulonephritis, nephrotic syndrome and resistance to standard treatment. This patient had a positive dynamics of clinical-laboratory-instrumental indicators and an improvement in the quality of life against the background of taking rituximab.

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A novel approach to induce early remission in high-risk primary membranous nephropathy

Kochoyan,

Dobronravov

2024

Nephrology Dialysis Transplantation

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Background and hypothesis This prospective single-arm trial with historic controls evaluated the efficacy and safety of treatment based on a combination of rituximab, intravenous cyclophosphamide, and corticosteroids (RCP) administered at lower cumulative doses for the induction of early remission in primary membranous nephropathy (PMN). Methods We prospectively enrolled 30 high-risk PMN patients with persistent nephrotic syndrome (NS) and elevated antibodies to the phospholipase A2 receptor who underwent RCP therapy. We compared the effectiveness of RCP with that of historic controls who received rituximab-based therapy (RTX, n = 15) or cyclosporine + corticosteroids (CSA, n = 42). The primary outcomes were complete remission (CR) and overall remission (OR) by month 12 and the time to remission. Results In the RCP group, the OR and CR rates by 12 months (97% and 60%) were higher than those in the RTX group (60% and 7%, P ≤ 0.009) and the CSA group (50% and 24%, P ≤ 0.003). The median time to OR (2.8 (1.6–3.9) months) was shorter compared to RTX (7.1 (3.4–17.5) months, P = 0.008) and CSA (7.3 (6.0–13.6) months, P < 0.001). In adjusted Cox regression, hazard ratios for OR and CR attainment for RCP versus other treatments were 5.2 (95% CI: 2.8–9.6) and 4.8 (95% CI: 2.2–10.3), respectively. Propensity score-matched group analyses confirmed these results. One serious adverse event occurred in the RCP group in the follow-up of 56 patient-years. Conclusions RCP therapy is considered effective and safe for inducing early remission in high-risk PMN patients.

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Treatment of membranous nephropathy: Perspectives on current and future therapies

Cited by 3 publications

References 78 publications

The Prevalence, Characteristics, and Putative Mechanisms of Dual Antigen-Positive Membranous Nephropathy: The Underestimated Condition

The Prevalence, Characteristics, and Putative Mechanisms of Dual Antigen-Positive Membranous Nephropathy: The Underestimated Condition

A clinical case of primary membranous glomerulonephritis with nephrotic syndrome and resistance to standard treatment

A novel approach to induce early remission in high-risk primary membranous nephropathy

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