The role of immunosuppressive therapy in membranous nephropathy

AIM: Membranous nephropathy is the most common cause of nephrotic syndrome in adults without a diagnosis of diabetes. It is classified as either primary or secondary. There is no universally accepted standard treatment regimen for membranous nephropathy. The aim of this study is to investigate the role of immunosuppressive treatment regimens in patients with membranous nephropathy. MATERIALS AND METHODS: In this study, 58 patients diagnosed with primary membranous nephropathy and followed by the nephrology clinic between January 2018 and January 2025 were evaluated. Patients were categorized as having primary or secondary membranous nephropathy. Clinical data were obtained through a review of outpatient follow-up records and the hospital database. RESULTS: Among the 58 patients included in the study, 81% were male and 19% were female, with a mean age of 53.1±11.9 years. The mean body weight was 78.5±13.5 kg and the mean height was 171.3±7.0 cm. The mean serum albümin level was 35.7±6.2 g/L, LDL cholesterol was 170.8±58.6 mg/dL, CRP was 3.3±0.8 mg/L, GFR was 82.4±34.9 mL/min, proteinuria was 3.63±0.68 g/day, hemoglobin was 13.5±1.8 g/dL, creatinine was 1.12±0.73 mg/dL, spot protein/creatinine ratio was 2940.3±4024, and spot albümin was 2153.9±3162 mg/day. Regarding treatment options, the most commonly used first-line therapies were cyclosporine (%39,7; n=23) and the Ponticelli protocol (31%; n=18), while 17.2% of the cases were followed conservative treatment. CONCLUSION: This study demonstrated the clinical effectiveness of various immunosuppressive treatment protocols in patients with primary membranous nephropathy. Treatment responses increased over time; however, remission could not be achieved in some patients. Different agents showed markedly different outcomes in terms of remission and relapse. Overall, individualized treatment strategies yielded remission rates consistent with the current literature. Additionally, In our case series of 6 patients, Obitinuzumab seems promising in patients who do not respond to classical treatments. Keywords: Anti-PLA2R antibody, immunosuppressive therapy, obinutuzumab, primary membranous nephropathy, proteinuria