Cargando…

How to Choose the Right Treatment for Membranous Nephropathy

Membranous nephropathy is an autoimmune disease affecting the glomeruli and is one of the most common causes of nephrotic syndrome. In the absence of any therapy, 35% of patients develop end-stage renal disease. The discovery of autoantibodies such as phospholipase A2 receptor 1, antithrombospondin...

Descripción completa

Detalles Bibliográficos
Autores principales: Peritore, Luigi, Labbozzetta, Vincenzo, Maressa, Veronica, Casuscelli, Chiara, Conti, Giovanni, Gembillo, Guido, Santoro, Domenico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673286/
https://www.ncbi.nlm.nih.gov/pubmed/38004046
http://dx.doi.org/10.3390/medicina59111997
_version_ 1785149593571295232
author Peritore, Luigi
Labbozzetta, Vincenzo
Maressa, Veronica
Casuscelli, Chiara
Conti, Giovanni
Gembillo, Guido
Santoro, Domenico
author_facet Peritore, Luigi
Labbozzetta, Vincenzo
Maressa, Veronica
Casuscelli, Chiara
Conti, Giovanni
Gembillo, Guido
Santoro, Domenico
author_sort Peritore, Luigi
collection PubMed
description Membranous nephropathy is an autoimmune disease affecting the glomeruli and is one of the most common causes of nephrotic syndrome. In the absence of any therapy, 35% of patients develop end-stage renal disease. The discovery of autoantibodies such as phospholipase A2 receptor 1, antithrombospondin and neural epidermal growth factor-like 1 protein has greatly helped us to understand the pathogenesis and enable the diagnosis of this disease and to guide its treatment. Depending on the complications of nephrotic syndrome, patients with this disease receive supportive treatment with diuretics, ACE inhibitors or angiotensin-receptor blockers, lipid-lowering agents and anticoagulants. After assessing the risk of progression of end-stage renal disease, patients receive immunosuppressive therapy with various drugs such as cyclophosphamide, steroids, calcineurin inhibitors or rituximab. Since immunosuppressive drugs can cause life-threatening side effects and up to 30% of patients do not respond to therapy, new therapeutic approaches with drugs such as adrenocorticotropic hormone, belimumab, anti-plasma cell antibodies or complement-guided drugs are currently being tested. However, special attention needs to be paid to the choice of therapy in secondary forms or in specific clinical contexts such as membranous disease in children, pregnant women and patients undergoing kidney transplantation.
format Online
Article
Text
id pubmed-10673286
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-106732862023-11-14 How to Choose the Right Treatment for Membranous Nephropathy Peritore, Luigi Labbozzetta, Vincenzo Maressa, Veronica Casuscelli, Chiara Conti, Giovanni Gembillo, Guido Santoro, Domenico Medicina (Kaunas) Review Membranous nephropathy is an autoimmune disease affecting the glomeruli and is one of the most common causes of nephrotic syndrome. In the absence of any therapy, 35% of patients develop end-stage renal disease. The discovery of autoantibodies such as phospholipase A2 receptor 1, antithrombospondin and neural epidermal growth factor-like 1 protein has greatly helped us to understand the pathogenesis and enable the diagnosis of this disease and to guide its treatment. Depending on the complications of nephrotic syndrome, patients with this disease receive supportive treatment with diuretics, ACE inhibitors or angiotensin-receptor blockers, lipid-lowering agents and anticoagulants. After assessing the risk of progression of end-stage renal disease, patients receive immunosuppressive therapy with various drugs such as cyclophosphamide, steroids, calcineurin inhibitors or rituximab. Since immunosuppressive drugs can cause life-threatening side effects and up to 30% of patients do not respond to therapy, new therapeutic approaches with drugs such as adrenocorticotropic hormone, belimumab, anti-plasma cell antibodies or complement-guided drugs are currently being tested. However, special attention needs to be paid to the choice of therapy in secondary forms or in specific clinical contexts such as membranous disease in children, pregnant women and patients undergoing kidney transplantation. MDPI 2023-11-14 /pmc/articles/PMC10673286/ /pubmed/38004046 http://dx.doi.org/10.3390/medicina59111997 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Peritore, Luigi
Labbozzetta, Vincenzo
Maressa, Veronica
Casuscelli, Chiara
Conti, Giovanni
Gembillo, Guido
Santoro, Domenico
How to Choose the Right Treatment for Membranous Nephropathy
title How to Choose the Right Treatment for Membranous Nephropathy
title_full How to Choose the Right Treatment for Membranous Nephropathy
title_fullStr How to Choose the Right Treatment for Membranous Nephropathy
title_full_unstemmed How to Choose the Right Treatment for Membranous Nephropathy
title_short How to Choose the Right Treatment for Membranous Nephropathy
title_sort how to choose the right treatment for membranous nephropathy
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673286/
https://www.ncbi.nlm.nih.gov/pubmed/38004046
http://dx.doi.org/10.3390/medicina59111997
work_keys_str_mv AT peritoreluigi howtochoosetherighttreatmentformembranousnephropathy
AT labbozzettavincenzo howtochoosetherighttreatmentformembranousnephropathy
AT maressaveronica howtochoosetherighttreatmentformembranousnephropathy
AT casuscellichiara howtochoosetherighttreatmentformembranousnephropathy
AT contigiovanni howtochoosetherighttreatmentformembranousnephropathy
AT gembilloguido howtochoosetherighttreatmentformembranousnephropathy
AT santorodomenico howtochoosetherighttreatmentformembranousnephropathy