Actualizacion del tratamiento de la glomerulonefritis membranosa primaria

Abstract

Introduction: Membranous nephropathy (MN) represents a glomerular disorder characterized by thickening of capillary walls due to immune complexes. This condition prevails as the primary cause of nephrotic syndrome in non-diabetic adults over 40 years old, although it also affects children less frequently. The estimated incidence varies geographically but remains constrained by the lack of representative studies. Although largely autoimmune and associated with anti-PLA2R antibodies, treatment addresses new therapies and emerging antibody discoveries.

Methodology: A literature review will be conducted to gather and analyze relevant studies on the treatment of primary membranous glomerulonephritis, using specific inclusion criteria. Irrelevant articles were excluded, and the search encompassed databases such as PubMed, Web of Science, and ProQuest, employing search terms and Boolean operators.

Discussion: Various studies on the treatment of primary membranous glomerulonephritis reveal diverse approaches. Cyclophosphamide expedited recovery in one study, while prednisone and rituximab yielded limited results. The amount of proteinuria proved critical in preserving renal function. Immunosuppressive therapy generally outperformed non-immunosuppressive approaches. Detection of high anti-PLA2R antibody levels indicated poor response to tacrolimus. Thyroid dysfunction and rituximab influenced outcomes. Antibody-guided therapy demonstrated high remission rates. Prophylactic aspirin or warfarin may benefit patients with low serum albumin.

Conclusion: The treatment of idiopathic membranous nephropathy is complex. Rituximab and antibody-guided therapy are effective, but the choice depends on factors such as age, antibodies, thyroid function, and others. A personalized approach is needed to enhance remission and patients' quality of life