Related Experiment Video
Updated: Oct 12, 2025
Mechanism of Kemeng Fang's Inhibition of Podocyte Apoptosis in Rats with Membranous Nephropathy through the PI3K/AKT Signaling Pathway
Published on: August 23, 2024
Immunosuppressive Therapy in Primary Membranous Nephropathy with Compromised Renal Function
Raja Ramachandran1, Rudreshwar Prabakaran1, Gnana Priya2
1Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Introduction:
Renal dysfunction at presentation is uncommon in primary membranous nephropathy (PMN). The data on the outcome of PMN patients with renal dysfunction at outset are scarce. The objective of the current study was to report the clinical outcomes of PMN patients with renal dysfunction.
Material And Methods:
This prospective longitudinal observational study included PMN patients (both incident and treatment resistant) with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. Immunosuppressive treatment was as per the unit's protocol. Patients were evaluated for proteinuria, creatinine, and serum albumin at monthly intervals for 6 months, then quarterly for a year, and then biannually. Both serum and tissue anti-PLA2R were performed at baseline.
Outcome:
Percentage of patients achieving clinical remission.
Results:
Sixty-four adults met study criteria and were analysed. The median (IQR) age of the patients was 48 (40, 56) years. PMN was PLA2R related in 52 (81.3%) patients. Twenty-eight (43.8%) and 30 (46.9%) patients were in remission at 12 months and at the end of the study [median (IQR) follow up: 24 months (12, 35)], respectively. Eight (12.5%) had progressed to end-stage renal disease at the last follow-up. Median (IQR) baseline anti-PLA2R titre was 150.1 RU/mL (38.5, 308). Nineteen (61.3%) and 18 (58.1%) patients with >90% reduction in anti-PLA2R titres at 12 months were in clinical remission at 12 months and at the end of the follow-up, respectively. Both cyclical cyclophosphamide/steroids (cCYC/GC) and rituximab were equally effective in inducing remission, but rituximab had a favourable adverse event profile compared to cCYC/GC.
Conclusion:
To conclude, both cCYC/GC and rituximab are equally effective in inducing remission of nephrotic state with compromised renal function due to PMN. Immunosuppression induces remission in up to 50% PMN patients with CKD-stage 3-4.
Insights
Primary membranous nephropathy (PMN) patients with impaired kidney function can achieve remission with immunosuppression. Both rituximab and cyclophosphamide/steroids are effective, with rituximab offering a better safety profile.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Primary membranous nephropathy (PMN) rarely presents with renal dysfunction.
- Clinical outcomes for PMN patients with initial renal impairment are not well-documented.
Purpose of the Study:
- To investigate the clinical outcomes of PMN patients presenting with renal dysfunction.
- To evaluate the effectiveness of immunosuppressive therapies in this patient cohort.
Main Methods:
- A prospective longitudinal observational study of PMN patients with estimated glomerular filtration rate <60 mL/min/1.73 m2.
- Patients received immunosuppressive treatment per unit protocol and were monitored for proteinuria, creatinine, and albumin.
- Baseline serum and tissue anti-phospholipase A2 receptor (anti-PLA2R) antibodies were assessed.
Main Results:
- Of 64 analyzed patients, 81.3% had PLA2R-related PMN. Remission was achieved by 43.8% at 12 months and 46.9% at study end (median follow-up 24 months).
- Eight patients (12.5%) progressed to end-stage renal disease. A >90% reduction in anti-PLA2R titres correlated with remission.
- Rituximab and cyclophosphamide/steroids (cCYC/GC) showed equal efficacy in inducing remission, but rituximab had a more favorable adverse event profile.
Conclusions:
- Both rituximab and cCYC/GC effectively induce remission in PMN patients with nephrotic syndrome and compromised renal function.
- Immunosuppression can lead to remission in approximately 50% of PMN patients with chronic kidney disease stages 3-4.
- Rituximab presents a safer alternative to cCYC/GC for treating PMN with renal impairment.
Related Concept Videos
01:24Nephrotic Syndrome III : Nursing Management
01:26Nephrotic Syndrome II : Assessment and Medical Management
01:16Kidney Transplant III: Nursing Management
01:24Nephrotic Syndrome I : Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...