Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n 1, 09100, Cagliari, Italy.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, USA.
J Nephrol. 2018 Aug;31(4):489-502. doi: 10.1007/s40620-017-0427-5. Epub 2017 Sep 5.
In the last 10 years, basic science and clinical research have made important contributions to the understanding and management of primary membranous nephropathy (MN). The identification of antibodies directed against the M-type phospholipase A receptor (PLA2R) and thrombospondin type-1 domain-containing 7A protein have added a new perspective on diagnosis, monitoring the immunological activity, predicting prognosis and guiding therapy in patients with primary MN. Mounting evidence suggests that quantification and follow-up of antiPLA2R Abs levels can help in assessing prognosis and evaluate the response to treatment. The kidney disease improving global outcomes guidelines published in 2012 have not been updated. New data on the use of rituximab suggest it should be considered as a potential initial therapy in the treatment of patients with primary MN.
在过去的 10 年中，基础科学和临床研究为理解和治疗原发性膜性肾病（MN）做出了重要贡献。针对 M 型磷脂酶 A 受体（PLA2R）和血栓反应蛋白 1 型结构域包含 7A 蛋白的抗体的鉴定为原发性 MN 患者的诊断、免疫活性监测、预后预测和治疗指导提供了新的视角。越来越多的证据表明，定量检测和随访抗 PLA2R Abs 水平有助于评估预后和评价治疗反应。2012 年发布的肾脏病预后质量倡议指南尚未更新。关于利妥昔单抗使用的新数据表明，它应该被考虑作为原发性 MN 患者初始治疗的一种潜在选择。
