Affiliation:
1. Nephrology, Haemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38043 Grenoble, France
2. Pathology Laboratory, Grenoble University Hospital, 38043 Grenoble, France
3. Faculty of Medicine, Grenoble Alpes University, 38043 Grenoble, France
Abstract
Membranous nephropathy constitutes approximately 20% of adult nephrotic syndrome cases. In approximately 80% of cases, membranous nephropathy is primary, mediated by IgG autoantibodies primarily targeting podocyte antigens (PLA2R, THSD7A, etc.). The treatment involves a combination of corticosteroids and cyclophosphamide or anti-CD20-based therapies, e.g., rituximab. In the event of significant proteinuria and in order to avoid the urinary elimination of rituximab, therapeutic apheresis, in particular semi-specific immunoadsorption, may be an option allowing for a reduction in proteinuria and autoantibodies before initiating treatment with rituximab. We present the preliminary experience of three patients treated with semi-specific immunoadsorption for primary membranous nephropathy between January 2021 and March 2023. Two patients were anti-PLA2R-autoantibody-positive and one was seronegative. The average age was 59 ± 17 years. Semi-specific immunoadsorption did not reduce albuminuria, but it, nevertheless, led to an increase in serum albumin, contributing to the regression of edema. It effectively eliminated anti-PLA2R autoantibodies in the two anti-PLA2R-positive patients. Consequently, apheresis may not induce a rapid reduction in proteinuria, but could contribute to a more accelerated remission when combined with the anti-CD20 treatment.
Reference40 articles.
1. B- and T-cell subpopulations in patients with severe idiopathic membranous nephropathy may predict an early response to rituximab;Rosenzwajg;Kidney Int.,2017
2. Membranous nephropathy: A review on the pathogenesis, diagnosis, and treatment;Lai;J. Formos. Med. Assoc.,2015
3. Ronco, P., Plaisier, E., and Debiec, H. (2021). Advances in Membranous Nephropathy. J. Clin. Med., 10.
4. Primary membranous nephropathy: Comprehensive review and historical perspective;Keri;Postgrad. Med. J.,2019
5. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy;Beck;N. Engl. J. Med.,2009
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