Treatment of High-Risk Idiopathic Membranous Nephropathy with Huaier Granules and RASi: A Case Series

Huaier Granules, an aqueous extract preparation of Trametes robiniophila Murr, has been verified effective in treating various malignant tumors. Many agents used for membranous nephropathy, including cyclophosphamide and rituximab (RTX), were initially developed for cancer therapy. However, no previous studies have explored its application in adult idiopathic membranous nephropathy (IMN). This case series analyzed clinical data of 2 high-risk IMN patients admitted to our hospital from 2023 to 2026. All patients were confirmed by renal biopsy and anti-phospholipase A2 receptor (anti-PLA2R) antibody testing. They received combined therapy of Huaier Granules plus renin-angiotensin system inhibitors (RASi) as the basic treatment. After over 12 months of treatment, laboratory results showed negative anti-PLA2R antibody levels; 24-hour urinary protein, serum albumin and estimated glomerular filtration rate (eGFR) were improved compared with baseline. Case 1 was followed up for 25 months and Case 2 was followed up for 21 months. Case 1 achieved complete clinical remission and Case 2 partial remission. No obvious adverse reactions related to Huaier Granules were observed, with good patient tolerance. This regimen may provide a new adjuvant therapeutic strategy for clinical management of IMN.