Membranous Nephropathy: Approaches to Treatment

Andrew S. Bomback, Fernando Custodio Fervenza

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Background: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. This review focuses on mechanisms involved in the pathogenesis of MN and approaches to treatment of this disease. Summary: Our understanding of the pathogenesis of primary MN has advanced greatly with the identification of M-type phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A as target antigens whose antibodies serve as biomarkers of this disease. Additional research, including investigations into the roles of complement and melanocortin receptors on the podocyte, may further improve our understanding of how best to treat this condition. Immunosuppressive therapies, including corticosteroids alternating with alkylating agents, and calcineurin inhibitors are partially successful in reducing proteinuria in MN, but their use may be associated with significant adverse effects and a high relapse rate. Novel interventions, including targeting B cells with rituximab as well as treatment with adrenocorticotropic hormone (ACTH), are being investigated. Key Messages: The understanding of treatment targets and availability of new biomarkers has facilitated diagnosis and improved risk stratification for MN and may also be useful for individualizing treatment with a wider range of therapeutic options for patients with MN. Considerable evidence supports the use of B-cell depletion as initial therapy in nephrotic patients with MN. ACTH should be considered for patients who do not respond to traditional therapies such as alkylating agents and calcineurin inhibitors.

Original languageEnglish (US)
Pages (from-to)30-42
Number of pages13
JournalAmerican Journal of Nephrology
Volume47
DOIs
StatePublished - Jun 1 2018

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Membranous Glomerulonephritis
Alkylating Agents
Therapeutics
Adrenocorticotropic Hormone
Phospholipase A2 Receptors
B-Lymphocytes
Biomarkers
Melanocortin Receptors
Thrombospondin 1
Complement Receptors
Podocytes
Nephrotic Syndrome
Immunosuppressive Agents
Proteinuria
Adrenal Cortex Hormones
Antigens
Recurrence
Antibodies

Keywords

  • Adrenocorticotropic hormone
  • Complement
  • Corticosteroid
  • Cyclophosphamide
  • Phospholipase A2 receptor
  • Rituximab

ASJC Scopus subject areas

  • Nephrology

Cite this

Membranous Nephropathy : Approaches to Treatment. / Bomback, Andrew S.; Fervenza, Fernando Custodio.

In: American Journal of Nephrology, Vol. 47, 01.06.2018, p. 30-42.

Research output: Contribution to journalReview article

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abstract = "Background: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. This review focuses on mechanisms involved in the pathogenesis of MN and approaches to treatment of this disease. Summary: Our understanding of the pathogenesis of primary MN has advanced greatly with the identification of M-type phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A as target antigens whose antibodies serve as biomarkers of this disease. Additional research, including investigations into the roles of complement and melanocortin receptors on the podocyte, may further improve our understanding of how best to treat this condition. Immunosuppressive therapies, including corticosteroids alternating with alkylating agents, and calcineurin inhibitors are partially successful in reducing proteinuria in MN, but their use may be associated with significant adverse effects and a high relapse rate. Novel interventions, including targeting B cells with rituximab as well as treatment with adrenocorticotropic hormone (ACTH), are being investigated. Key Messages: The understanding of treatment targets and availability of new biomarkers has facilitated diagnosis and improved risk stratification for MN and may also be useful for individualizing treatment with a wider range of therapeutic options for patients with MN. Considerable evidence supports the use of B-cell depletion as initial therapy in nephrotic patients with MN. ACTH should be considered for patients who do not respond to traditional therapies such as alkylating agents and calcineurin inhibitors.",
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