genitourinary disorders
Membranous Nephropathy
Treatment of Membranous Nephropathy
Control of nephrotic-range proteinuria and/or edema with diuretics Treatment of secondary causes of nephrotic syndrome as indicated Immunosuppressive therapy for patients with symptomatic idiopathic membranous nephropathy at high risk of progression Kidney transplantation for patients with end-stage kidney disease Primary treatment is that of the causes. Among patients with idiopathic membranous nephropathy, asymptomatic patients with non–nephrotic-range proteinuria do not require treatment; renal function should be monitored periodically (eg, twice yearly when apparently stable). Patients with nephrotic-range proteinuria who are asymptomatic or who have edema should be treated with diuretics. Patients with hypertension should be given an angiotensin-converting enzyme (ACE) inhibitor orangiotensin IIreceptor blocker (ARB); these medications may also benefit patients without hypertension by reducing proteinuria. Immunosuppressants should be considered only for patients with symptomatic idiopathic membranous nephropathy and for those most at risk of progressive disease. While there is no strong evidence that immunosuppressive therapy has a long-term benefit for patient or kidney survival, it appears to improve rates of remission and possibly progression to end-stage kidney disease (ESKD) ( Treatment references ). Older and chronically ill patients are at greater risk of infectious complications due to immunosuppressants. and corticosteroids ( Treatment references ). Alternatives to Therapies of unproven long-term value include IV immune globulin and nonsteroidal anti-inflammatory drugs (NSAIDs). Kidney Transplantation is an option for patients with end-stage kidney disease. Membranous nephropathy recurs in about 10% of patients, with loss of graft in up to 50%. 1.von Groote TC, Williams G, Au EH, et al: Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome.Cochrane Database Syst Rev11(11):CD004293, 2021. doi: 10.1002/14651858.CD004293.pub4 2.Fervenza FC, Appel GB, Barbour SJ, et al:Rituximaborcyclosporinein the treatment of membranous nephropathy.N Engl J Med381(1):36-46, 2019. doi: 10.1056/NEJMoa1814427 3.Ponticelli C, Altieri P, Scolari F, et al: A randomized study comparingmethylprednisolonepluschlorambucilversusmethylprednisolonepluscyclophosphamidein idiopathic membranous nephropathy.J Am Soc Nephrol9(3):444, 1998. doi: 10.1681/ASN.V93444 