Pharmacotherapy options for membranous nephropathy

Introduction: Membranous nephropathy (MN) is a rare, antibody-mediated glomerular disease that causes nephrotic syndrome in adults. It is a chronic disease with spontaneous remissions in approximately 30% of patients. The reminder, however, experience long periods of nephrotic syndrome and progress toward end-stage renal diseases. The ideal treatment for patients with MN is still matter of debate.Areas covered: The PubMed database was searched for original articles and reviews published up to August 2015. The search terms were: ‘membranous nephropathy’, ‘prognosis’, ‘pathogenesis’, and ‘treatment’.Expert opinion: Steroids in association with alkylating agents and calcineurin inhibitors are currently used and recommended by international guidelines as treatment of choice in MN. However the treatment benefits are uncertain, and often offset by adverse events. Evidence that B-cell function plays a role in the pathophysiology of this condition has suggested that rituximab, a monoclonal antibody that binds to CD20 antigen on B-cell surface, may be an alternative therapeutic option in MN. Indeed, experience accumulated during the last 10 years has shown that rituximab is effective in inducing remission of proteinuria, with the advantage of a superior safety profile.