07 February 2021: Review Articles
A Review of the Current Practice of Diagnosis and Treatment of Idiopathic Membranous Nephropathy in China
Lianzhong Wu 12AE* , Jin Lai 12B* , Yixin Ling 12C , Yiqin Weng 12B , Shujuan Zhou 1D , Siqi Wu 2D , Songfu Jiang 1D , Xiaokai Ding 3D , Xin Jin 4EFG* , Kang Yu 1EF* , Yi Chen 1EF*DOI: 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. | ||