Membranous nephropathy treatment standard

Author:

Radhakrishnan Yeshwanter1,Zand Ladan1,Sethi Sanjeev12ORCID,Fervenza Fernando C1ORCID

Affiliation:

1. Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic , Rochester, MN , USA

2. Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN , USA

Abstract

ABSTRACT Membranous nephropathy (MN) is characterized by deposition of immune complexes leading to thickening of glomerular basement membranes. Over time, the understanding of MN has evolved, with the identification of specific autoantibodies against novel podocyte antigens and the unraveling of intricate pathogenic pathways. Although the anti-CD20 monoclonal antibody rituximab is favored as part of the initial therapy in MN, a subgroup of MN patients may be resistant to rituximab necessitating the use of alternative agents such as cytotoxic therapies. In addition, newer agents such as novel anti-CD20 monoclonal antibodies, therapies targeting the CD38-positive plasma cells and anti-complement therapy are being studied in patients who are resistant to traditional treatment strategies. This manuscript furnishes a review of the novel developments in the pathophysiology of MN including the identification of target antigens and current treatment standards for MN, concentrating on evidenced-based interventions designed to attain remission and to prevent disease progression.

Funder

Mayo Foundation

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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