Membranous nephropathy treatment

Schieppati A, Perna A, Zamora J, Giuhano GA, Braun N, Remuzzi G. Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome. Cochrane Database Syst Rev 2004. 

Despite a good overall safety profile, anti-TNF antibodies can induce a number of adverse effects, including autoimmunity and infections. A trial in the treatment of Crohn s disease noted infusion reactions, transient increased of anti-dsDNA antibodies, and serum sickness-like delayed hypersensitivity with retreatment. Induction of human-antichimeric-antibodies was suggested as the cause of some of the infusion reactions [90]. A prospective study in 35 patients with Crohn s disease showed induction of ANA and anti-dsDNA autoantibodies in 53% and 35% of infliximab-treated patients [91]. A single patient showed clinical features consistent with drug-induced lupus, including the presence of ANA and anti-dsDNA autoantibodies, which quickly resolved after discontinuation of infliximab. Reports on renal adverse effects of anti-TNF antibodies are very rare. Saint Marcoux described the occurrence of crescentic GN in as few as 2 patients out of a cohort of 39 patients, treated with an anti-TNF antibody for rheumatoid arthritis [92]. A case report by Chin et al. [93] described the case of a 29-year-old Australia-born Vietnamese who presented with nephrotic syndrome. A renal biopsy showed membranous nephropathy. Symptoms attenuated after discontinuation of infliximab therapy. 

There is no specific treatment for mercury poisoning of the kidneys but removal of the source of the metal is important. This maneuver may result in spontaneous improvement in 50% of cases [25]. Brown, in a study from Malawi, described the failure to improve in 2 out of 6 patients with membranous nephropathy who were known to have used skin creams [28]. This occurred despite removal from exposure to the mercury as well as the administration of steroids. 

The optimal treatment for membranous nephropathy is controversial since there is no consistently effective drug regimen. 

The treatment of secondary membranous nephropathy is directed at removing the underlying cause. For instance, membranous nephropathy secondary to syphilis can be treated with peni-cUfin. a-Interferon is beneficial for hepatitis B-induced membranous nephropathy. Corticosteroids should be avoided because they may induce transient viral replication. ... 

Geddes CC, Cattran DC. The treatment of idiopathic membranous nephropathy. Semin Nephrol 2000 20 299-308. 

Rostoker G, Maadi AB, Remy P, et al. Low-dose angiotensin-converting-enzyme inhibitor captopril to reduce proteinuria in adult idiopathic membranous nephropathy A prospective study of long-term treatment. Nephrol Dial Transplant 1995 10 25-29. 

Branten AJ, Reichert LJ, Koene RA, et al. Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency. QJM 1998 91 359-366. 

Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int 1995 47 225-230. 

Cameron JS (1990) Membranous nephropathy in childhood and its treatment. Pediatr Nephrol 4 193-198 Cameron JS (1999) Lupus nephritis. J Am Soc Nephrol 10 413-424... 

This MRL was based on a NOAEL of 0.23 mg Hg/kg/day for renal effects in rats administered mercuric chloride 5 days a week for 6 months (Dieter et al. 1992 NTP 1993). This dose was duration-adjusted for a 5 day/week exposure and divided by an uncertainty factor of 100 (10 for extrapolation from animals to humans and 10 for human variability). Increased absolute and relative kidney weights were observed in rats exposed to 0.46 mg Hg/kg/day, the next higher treatment level. At higher doses, an increased incidence of nephropathy (described as foci of tubular regeneration, thickened tubular basement membrane, and scattered dilated tubules containing hyaline casts) was observed. Renal toxicity is a... 

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