Idiopathic membranous nephropathy: outline and rationale of a treatment strategy.
Idiopathic membranous nephropathy is a common cause of nephrotic syndrome. The treatment of patients with idiopathic membranous nephropathy is heavily debated. Based on literature data and our own experience, we propose a rational treatment strategy. Patients with renal insufficiency (serum creatinine level > 1.5 mg/dL [> 135 micromol/L]) are at greatest risk for the development of end-stage renal disease and should receive immunosuppressive therapy. In patients with normal renal function (serum creatinine level < 1.5 mg/dL [< 135 micromol/L]), risk for developing end-stage renal disease can be estimated by measuring urinary excretion of beta2-microglobulin or alpha1-microglobulin and immunoglobulin G. For low-risk patients, a wait-and-see policy is advised. High-risk patients likely benefit from immunosuppressive therapy. Currently, combinations of steroids with chlorambucil or cyclophosphamide are the best studied. We prefer cyclophosphamide in view of its fewer side effects. Cyclosporine may be an alternative option in patients with well-preserved renal function, although long-term data are lacking. Other immunosuppressive agents, such as mycophenolate mofetil or rituximab, currently are under study; however, data are insufficient to support their routine use.
du Buf-Vereijken
Peggy W G
PW
Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Branten
Amanda J W
AJ
Wetzels
Jack F M
JF
D000510:Alpha-Globulins / Q000652:urine; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019090:Case Management; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D007074:Immunoglobulin G / Q000652:urine; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D009404:Nephrotic Syndrome / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000652:urine
D000510:Alpha-Globulins; D000806:Angiotensin-Converting Enzyme Inhibitors; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D001613:beta 2-Microglobulin; C025734:chorionic alpha(1)-microglobulin; D003404:Creatinine