Newer B-cell and plasma-cell targeted treatments for rituximab-resistant patients with membranous nephropathy

Membranous nephropathy is the most common cause of nephrotic syndrome in adults. While spontaneous remission occurs in approximately one-third of cases, another one-third of patients receiving immunosuppressive therapy demonstrate treatment resistance. This resistance, coupled with persistent proteinuria, significantly increases the risk of kidney failure. Alternative therapies, including B-cell and plasma-cell targeted treatments have been explored in isolated cases and case series. In this review, we examine the available evidence on the treatment of resistant and relapsing membranous nephropathy with a particular focus on B- and plasma-cell directed therapies.