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Pathophysiology, diagnosis, and treatment of membranous nephropathy

Jens Lutz1

  • 1Medical Clinic, Nephrology-Infectious Diseases, Central Rhine hospital group, Gemeinschaftsklinikum Mittelrhein, Koblenzer Straße 115-155, 56073 Koblenz, Germany.

Nephrologie & Therapeutique
|April 29, 2021
PubMed

Insights

Adult membranous nephropathy (MN) involves immune complexes and autoantibodies against PLA2R and THSD7A. New antigens and targeted therapies like rituximab offer improved treatment strategies for this kidney disease.

Area of Science:

  • Nephrology
  • Immunology
  • Pathology

Background:

  • Membranous nephropathy (MN) is a primary cause of nephrotic syndrome in adults.
  • It is characterized by glomerular basement membrane thickening and immune complex deposition.
  • Autoantibodies against PLA2R and THSD7A are key diagnostic biomarkers.

Purpose of the Study:

  • To review current understanding of membranous nephropathy pathogenesis and diagnosis.
  • To discuss advancements in immunosuppressive therapies and antibody removal techniques.
  • To highlight the need for targeted treatments against autoantibodies in MN.

Main Methods:

  • Review of recent literature on membranous nephropathy.
  • Analysis of diagnostic biomarkers including autoantibodies.
  • Evaluation of current and emerging treatment strategies.

Main Results:

  • Identification of novel antigens (NELL-1, exostosin 1/2) in MN.
  • Classification of MN into antibody-positive and antibody-negative forms.
  • Efficacy of B-cell targeted therapies like rituximab alongside traditional immunosuppressants.

Conclusions:

  • MN classification should incorporate antibody status.
  • Targeted immunosuppression against autoantibodies is crucial for kidney protection.
  • Further research is needed to optimize treatments for autoimmune kidney damage.
Keywords:
Chronic kidney diseaseEpitope spreadingIg subclassesPLA2RRituximabTHSD7A

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