Publication year
2005Source
American Journal of Kidney Diseases, 46, 6, (2005), pp. 1012-29ISSN
Publication type
Article / Letter to editor
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Organization
Nephrology
Journal title
American Journal of Kidney Diseases
Volume
vol. 46
Issue
iss. 6
Page start
p. 1012
Page end
p. 29
Subject
IGMD 7: Iron metabolism; IGMD 9: Renal disorder; UMCN 4.2: Chronic inflammation and autoimmunity; UMCN 5.4: Renal disordersAbstract
Idiopathic membranous nephropathy is a common cause of nephrotic syndrome. The treatment of patients with idiopathic membranous nephropathy is heavily debated. Based on literature data and our own experience, we propose a rational treatment strategy. Patients with renal insufficiency (serum creatinine level > 1.5 mg/dL [> 135 micromol/L]) are at greatest risk for the development of end-stage renal disease and should receive immunosuppressive therapy. In patients with normal renal function (serum creatinine level < 1.5 mg/dL [< 135 micromol/L]), risk for developing end-stage renal disease can be estimated by measuring urinary excretion of beta2-microglobulin or alpha1-microglobulin and immunoglobulin G. For low-risk patients, a wait-and-see policy is advised. High-risk patients likely benefit from immunosuppressive therapy. Currently, combinations of steroids with chlorambucil or cyclophosphamide are the best studied. We prefer cyclophosphamide in view of its fewer side effects. Cyclosporine may be an alternative option in patients with well-preserved renal function, although long-term data are lacking. Other immunosuppressive agents, such as mycophenolate mofetil or rituximab, currently are under study; however, data are insufficient to support their routine use.
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- Faculty of Medical Sciences [90359]
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