Update on Membranous Nephropathy
- 75% of MN is considered primary (idiopathic).
- IgG4 subclass is predominant in idiopathic MN.
- Anti-PLA2R is highly specific for primary MN
- Co-localization of PLA2R and IgG4 within immune deposits on biopsy.
- The majority of patients with primary MN have circulating autoantibodies against PLA2R.
- Ponticelli regimen: methylprednisolone 1g/d iv x 3 doses followed by oral prednisone 0.5mg/kg/d in months 1,3,5; oral cyclophosphamide (2mg/kg/d) in months 2,4,6.
- Alternative initial therapy for those who refuse or have contraindications to cyclophosphamide is Calcineurin inhibitor (CNI) for at least 6 months.
- Stop if no remission in 6 months.
- If remission is attained, reduce dose every 1-2 mo by 50% and continue for at least 12 months
Source: http://renalfellow.blogspot.com/2013/06/update-on-membranous-nephropathy.html
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