Immunosuppressive Therapy in Primary Membranous Nephropathy with Compromised Renal Function.

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.