Buse Marc, Dounousi Evangelia, Kramann Rafael, Floege Jürgen, Stamellou Eleni
Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.
Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece.
Clin Kidney J. 2025 Mar 21;18(5):sfaf088. doi: 10.1093/ckj/sfaf088. eCollection 2025 May.
Membranous nephropathy is the most common cause of nephrotic syndrome in adults. While spontaneous remission occurs in approximately one-third of cases, another one-third of patients receiving immunosuppressive therapy demonstrate treatment resistance. This resistance, coupled with persistent proteinuria, significantly increases the risk of kidney failure. Alternative therapies, including B-cell and plasma-cell targeted treatments have been explored in isolated cases and case series. In this review, we examine the available evidence on the treatment of resistant and relapsing membranous nephropathy with a particular focus on B- and plasma-cell directed therapies.
膜性肾病是成人肾病综合征最常见的病因。虽然约三分之一的病例会自发缓解，但接受免疫抑制治疗的患者中另有三分之一表现出治疗抵抗。这种抵抗加上持续性蛋白尿，显著增加了肾衰竭的风险。在个别病例和病例系列中已探索了包括针对B细胞和浆细胞的治疗在内的替代疗法。在本综述中，我们研究了关于难治性和复发性膜性肾病治疗的现有证据，特别关注针对B细胞和浆细胞的疗法。
