What to do about membranous nephropathy? The two most effective treatments

Membranous nephropathy is a pathological diagnosis and a major cause of nephrotic syndrome. There are two types of membranous nephropathy: idiopathic and secondary. So, what kind of treatment is used clinically for this disease?

1. Non-immune treatment

Targeted at young patients with urine protein <3.5g/day, normal or slightly decreased plasma albumin, and normal renal function.

(1) Control blood pressure. Blood pressure should be controlled below 125/70 mmHg. The preferred medications are angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB).

(2) Anticoagulant therapy: In view of the high incidence of venous thrombosis in patients with membranous nephropathy, anticoagulant therapy can be given preventively. Patients with high-risk factors (urinary protein persistently >8g/day, plasma protein <20g/L, use of diuretics or long-term bed rest, etc.) should be actively treated with anticoagulant therapy. Low molecular weight heparin injection is the first choice of drug. If the patient has long-term hypoproteinemia, switching to oral warfarin anticoagulant therapy can be considered, but coagulation function needs to be closely monitored.

(3) Low-protein diet: For patients with heavy proteinuria, the protein intake in their diet should be limited to 0.8 g/(kg·d), while providing sufficient calories. The total calories should generally be guaranteed to be 146.54 kJ (35 kcal)/(kg·d).

(4) Others include treatment of edema, hyperlipidemia, etc.

2. Immunotherapy

Immunosuppressive therapy depends on the degree and duration of proteinuria and the state of renal function. It is generally believed that high-risk patients with proteinuria >3.5g/day and decreased renal function, or proteinuria >8g/day should be given immunotherapy.

There is also a lot of controversy about the immunotherapy regimen for membranous nephropathy and its efficacy evaluation. It is generally believed that the use of glucocorticoids (hereinafter referred to as hormones) alone is ineffective, and hormones + cyclophosphamide (CTX) or cyclosporine A (CsA) treatment can achieve clinical relief in some patients. The judgment of efficacy does not necessarily pursue complete relief (urine protein ≤ 0.3g/day), and partial relief (urine protein ≤ 3.5g/day or urine protein decrease > 50%, serum albumin > 30g/L) can also effectively improve the patient's prognosis.