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Alternative agents in the treatment of idiopathic membranous nephropathy

Jack FM Wetzels, MD, PhD
Gerald B Appel, MD
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
Albert Q Lam, MD


Membranous nephropathy (MN) is among the most common causes of the nephrotic syndrome in nondiabetic adults. (See "Overview of heavy proteinuria and the nephrotic syndrome", section on 'Etiology'.)

MN is most often idiopathic but may also be caused by a variety of drugs and underlying diseases including gold, mercury (elemental, organic, inorganic), penicillamine, NSAIDs, systemic lupus erythematosus, malignancy, and hepatitis B and C (table 1). In patients with secondary MN, cessation of the offending drug or effective treatment of the underlying disease is usually associated with improvement in the nephrotic syndrome. (See "Causes and diagnosis of membranous nephropathy".)

Untreated patients with idiopathic MN have an appreciable incidence of partial or complete remission over a period of three to four years [1,2]. Thus, while almost all patients with idiopathic MN should receive nonimmunosuppressive therapies (eg, angiotensin inhibition, other antihypertensive drugs to achieve the goal blood pressure, salt restriction and diuretics for control of edema and statins for hyperlipidemia), immunosuppressive therapy should be limited to patients who are at high risk for progression of disease.

The identification of patients who are at risk for progression of disease and the indications for the treatment of MN are discussed elsewhere. (See "Treatment of idiopathic membranous nephropathy".)

The primary regimens used to treat idiopathic MN include a cytotoxic drug (cyclophosphamide or, less often, chlorambucil) plus glucocorticoids or calcineurin inhibitors with or without glucocorticoids. Rituximab is also occasionally used. The therapy of idiopathic MN with these agents is discussed elsewhere. (See "Treatment of idiopathic membranous nephropathy".)

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Literature review current through: Nov 2017. | This topic last updated: Feb 04, 2016.
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