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Spontaneous remission in primary membranous nephropathy: mechanisms, predictive factors, and implications for

Mengqi Wu1, Yanhao Chen2, Zixin He3

  • 1Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.

Frontiers in Immunology
|September 29, 2025
PubMed

Insights

Primary membranous nephropathy (PMN) remission is driven by immune modulation and tissue repair. Understanding these factors guides personalized treatment, reducing unnecessary immunosuppression for patients with nephrotic syndrome.

Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • Primary membranous nephropathy (PMN) is a leading cause of adult nephrotic syndrome.
  • PMN exhibits significant clinical heterogeneity, complicating management.
  • Spontaneous remission (SR) in PMN is a key clinical outcome influenced by various factors.

Purpose of the Study:

  • To review current evidence on immunological mechanisms and clinical predictors of spontaneous remission (SR) in PMN.
  • To propose a staged immune modulation process underlying SR.
  • To outline a personalized treatment approach for PMN based on risk stratification and monitoring.

Main Methods:

  • Literature review of immunological mechanisms and clinical predictors of SR in PMN.
  • Analysis of factors including anti-PLA2R antibodies, proteinuria, renal function, and biomarkers.
  • Synthesis of evidence to propose an immune modulation process and personalized treatment strategy.

Main Results:

  • Key predictors of SR include dynamics of anti-PLA2R antibodies, proteinuria trends, renal function, histopathology, and biomarkers.
  • A staged immune modulation process involving autoreactive response suppression and tissue repair is proposed.
  • Personalized treatment strategies can be developed using dynamic risk stratification and longitudinal monitoring.

Conclusions:

  • Understanding the drivers of SR in PMN is crucial for effective patient management.
  • Identifying SR predictors can help minimize unnecessary immunosuppression.
  • Precision management of PMN can be achieved by integrating immunological insights and clinical monitoring.
Keywords:
anti-PLA2R antibodyprecision therapyprimary membranous nephropathyrisk stratificationspontaneous remission

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