Naciri Bennani Hamza, Banza Augustin Twite, Giovannini Diane, Motte Lionel, Noble Johan, Corbu Alexandra, Malvezzi Paolo, Jouve Thomas, Rostaing Lionel
Nephrology, Haemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38043 Grenoble, France.
Pathology Laboratory, Grenoble University Hospital, 38043 Grenoble, France.
J Pers Med. 2024 Feb 26;14(3):249. doi: 10.3390/jpm14030249.
Membranous nephropathy constitutes approximately 20% of adult nephrotic syndrome cases. In approximately 80% of cases, membranous nephropathy is primary, mediated by IgG autoantibodies primarily targeting podocyte antigens (PLA2R, THSD7A, etc.). The treatment involves a combination of corticosteroids and cyclophosphamide or anti-CD20-based therapies, e.g., rituximab. In the event of significant proteinuria and in order to avoid the urinary elimination of rituximab, therapeutic apheresis, in particular semi-specific immunoadsorption, may be an option allowing for a reduction in proteinuria and autoantibodies before initiating treatment with rituximab. We present the preliminary experience of three patients treated with semi-specific immunoadsorption for primary membranous nephropathy between January 2021 and March 2023. Two patients were anti-PLA2R-autoantibody-positive and one was seronegative. The average age was 59 ± 17 years. Semi-specific immunoadsorption did not reduce albuminuria, but it, nevertheless, led to an increase in serum albumin, contributing to the regression of edema. It effectively eliminated anti-PLA2R autoantibodies in the two anti-PLA2R-positive patients. Consequently, apheresis may not induce a rapid reduction in proteinuria, but could contribute to a more accelerated remission when combined with the anti-CD20 treatment.
膜性肾病约占成人肾病综合征病例的20%。在大约80%的病例中，膜性肾病是原发性的，由主要靶向足细胞抗原（如磷脂酶A2受体[PLA2R]、血小板反应蛋白7A[THSD7A]等）的IgG自身抗体介导。治疗方法包括皮质类固醇与环磷酰胺联合使用或基于抗CD20的疗法，如利妥昔单抗。如果出现大量蛋白尿，为避免利妥昔单抗经尿液排出，治疗性血液成分单采术，特别是半特异性免疫吸附，可能是一种在开始使用利妥昔单抗治疗前可减少蛋白尿和自身抗体的选择。我们介绍了2021年1月至2023年3月期间接受半特异性免疫吸附治疗原发性膜性肾病的3例患者的初步经验。2例患者抗PLA2R自身抗体阳性，1例血清学阴性。平均年龄为59±17岁。半特异性免疫吸附并未降低蛋白尿，但导致血清白蛋白增加，有助于水肿消退。它有效清除了2例抗PLA2R阳性患者的抗PLA2R自身抗体。因此，血液成分单采术可能不会迅速降低蛋白尿，但与抗CD20治疗联合使用时可能有助于更快缓解。
