update on treatment of membranous nephropathy -...
TRANSCRIPT
Update on Treatment of Membranous Nephropathy
F.Pourrezagholi
SBMU
Labbaffnejad Medical CENTER
Most common primary glomerular disease in older adults (>60 yr)
Most common cause of nephroticsyndrome in nondiabetic adults
More common in whites & asians than blacks
70-80% “Idiopathic”
20-30% Secondary
Incidence: 1.2/100,000/yr worldwide
Male:Female 2:1 ratio
Causes at least 0.7% of cases of ESRD (USRDS)
Membranous Nephropathy:
MN in adults is most often idiopathic(approximately 75%)
Secondary causes
Drugsgold,pnicillamine
infectionshepatitis B and C virus infection
underlying diseasesSLE,malignancy
Treatment algorithm
for MGN based on the
2012 KDIGO
2012
conclusion
A protocol based on a novel combination of rituximab and cyclosporine that targets both the B-cell and T-cell limbs of the immune system
Three Main RCT
Treatment protocol
comparison between the efficacy of sequential
tacrolimus–rituximab therapy with a modified Ponticelliprotocol (steroids plus cyclophosphamide)
The result of this study will be done by 2018.
percentage
changes in proteinuria
Serum albumin level
Anti-PLA2R-AB level
serum albumin and PLA2R-Ab levels are early markers of NIAT-rituximab efficacy
criteria for definition of remission should include serum albumin and PLA2R-Ab levels
conclusion
Take home …….
