07 February 2021 : Review article
A Review of the Current Practice of Diagnosis and Treatment of Idiopathic Membranous Nephropathy in China
Lianzhong Wu12AE, Jin Lai12B, Yixin Ling12C, Yiqin Weng12B, Shujuan Zhou1D, Siqi Wu2D, Songfu Jiang1D, Xiaokai Ding3D, Xin Jin4EFG, Kang Yu1EF*, Yi Chen1EFDOI: 10.12659/MSM.930097
Med Sci Monit 2021; 27:e930097
Background
Research Progress in the Pathogenesis of IMN
Experimental Animal Models
Complement Activation and IMN
New Diagnostic Biomarkers
Genetic Background
Treatment of IMN
Renin-Angiotensin System Inhibitors
Glucocorticoids
Cyclophosphamide
Calcineurin Inhibitors
Adrenocorticotropic Hormone
Rituximab Therapy
Mycophenolate Mofetil
Traditional Chinese Medicine
New Approaches and Remaining Clinical Challenges
Conclusions
References
Table 2 A summary of the advantages and disadvantages of various treatment approaches for idiopathic membranous nephropathy in China.
| Treatment | Advantages | Disadvantages |
|---|---|---|
| Renin-angiotensin system inhibitors | Reduced proteinuria; renal protection | High potassium, AKI; lack of evidence regarding long-term prognosis |
| Glucocorticoids | Inexpensive and easy to obtain; considered to have some effect on Chinese patients | Lack of RCT evidence and recommendations; adverse effects with long-term use |
| Cyclophosphamide | Reduced proteinuria; renal function protection; can be used in severe cases | Adverse reactions, especially gonadal suppression; lack of evidence for oral and intravenous use |
| Calcineurin inhibitors | Reduced proteinuria; renal protection | Price; nephrotoxicity; high recurrence rate (CSA); hyperglycemia (TAC) |
| Adrenocorticotropic hormone | Reduced proteinuria; renal protection | Price; difficult to obtain; limited clinical evidence; adverse reactions |
| Rituximab | Alternative therapy for patients with poor response to conventional therapy; potential as first-line therapy | Price; a certain probability of nonresponse; adverse reactions |
| Mycophenolate mofetil | Alternative therapy for patients with poor response to conventional therapy | Lack of RCT evidence; price; adverse reactions |
| Traditional Chinese medicine | Improved symptoms; increased efficacy of conventional drugs; reduced adverse reactions to conventional drugs | Lack of RCT evidence and pharmacological mechanism research |
| AKI – acute kidney injury; CSA – cyclosporine A; RCT – randomized controlled trial; TAC – tacrolimus. | ||