Treatment of membranous nephropathy focuses on addressing the cause of your disease and relieving your symptoms. There is no certain cure.
In cases where membranous nephropathy is caused by a medication or another disease — such as a cancerous tumor — stopping the medication or controlling the other disease usually improves the condition.
Low risk of advanced kidney disease
With membranous nephropathy, you're considered at low risk of developing advanced kidney disease in the next five years if:
- Your urine protein level remains less than 4 grams a day for six months
- Your blood creatinine level remains in the normal range for six months
If you're at low risk of advanced kidney disease, treatment of membranous nephropathy usually begins with conservative measures, including:
- Controlling blood pressure with medications that block the angiotensin II system, such as angiotensin-converting enzyme (ACE) inhibitors
- Decreasing swelling (edema) with water pills (diuretics), which help remove sodium and water from your blood
- Controlling cholesterol levels with statin medications
- Decreasing blood clot risk with an anticoagulant medication
- Reducing the amount of salt in your diet
Up to 30 percent of people with membranous nephropathy have a complete resolution of symptoms (remission) after five years without any treatment, and 25 to 40 percent have a partial remission. Doctors generally prefer to avoid using strong drugs — and their potential side effects — early in the course of the disease, when there's a chance that the disease will improve on its own.
Moderate to high risk of advanced kidney disease
Your doctor may recommend more intensive treatment as the amount of protein in your urine increases. The greater the protein level, the greater the risk to your health:
- Moderate risk. With membranous nephropathy, you're considered at moderate risk of advanced kidney disease if your urine protein level stays between 4 and 8 grams a day with a blood creatinine level at normal or near normal during six months of observation. About half the people with these signs develop serious kidney disease over five years.
- High risk. With membranous nephropathy, you're considered at high risk of advanced kidney disease if your urine protein level is persistently greater than 8 grams a day for three months or if your kidney function is below normal or falls below normal during the observation period. About 3 in 4 people with these signs have a high risk of progressing to serious kidney disease over five years.
For those at moderate to high risk of developing advanced kidney disease, treatment of membranous nephropathy might include:
Oct. 21, 2014
Medications to suppress your immune system. If your proteinuria is getting worse, your doctor may prescribe a combination of a corticosteroid medication with a chemotherapy drug to suppress your immune system. Alternatively, a type of drug called a calcineurin inhibitor might be given if you can't tolerate or choose not to take a chemotherapy drug.
These medications can effectively reduce urine protein levels and stop the progress toward kidney failure. But the medications have significant side effects, they don't help everyone, and symptoms return for many people after treatment ends. Some of the side effects of chemotherapy drugs — such as risk of bladder cancer, leukemia and infertility — may occur many years after taking the drug.
If you don't respond to a first course of immunosuppressive therapy, or you have a relapse, you may benefit from a second course of treatment.
- Rituximab (Rituxan). Rituximab has shown effectiveness in people who haven't benefited from immunosuppressive therapy. The drug kills B cells in the immune system — the cells that produce antibodies that damage the glomeruli. However, use of this drug is still experimental and rituximab is expensive and not generally covered by insurance.
- Gilbert SJ, et al. National Kidney Foundation's Primer on Kidney Diseases. 6th ed. Philadelphia, PA.: Elsevier/Saunders; 2014. http://www.clinicalkey.com. Accessed Aug. 14, 2014.
- Cattran DC. Treatment of idiopathic membranous nephropathy. http://www.uptodate.com/home. Accessed Aug. 14, 2014.
- Beck LH, et al. Causes and diagnosis of membranous nephropathy. http://www.uptodate.com/home. Accessed Aug. 14, 2014.
- Nephrotic syndrome in adults. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). http://kidney.niddk.nih.gov/kudiseases/pubs/nephrotic/. Accessed Aug. 28, 2014.
- Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Aug. 27, 2014.
- Herrmann SMS, et al. Membranous nephropathy: The start of a paradigm shift. Current opinion in nephrology and hypertension. 2012;21:203.
- Glomerular filtration rate (GFR). National Kidney Foundation. http://www.kidney.org/atoz/content/gfr.cfm. Accessed Sept. 3, 2014.
- Hogan J, et al. Diagnostic tests and treatment options in glomerular disease: 2014 update. American Journal of Kidney Diseases. 2014;63:656.
- Hofstra JM, et al. Treatment of idiopathic membranous nephropathy. Nature Reviews Nephrology. 2013;9:443.
- Riggin EA. Decision Support System. Mayo Clinic, Rochester, Minn. June 20, 2014.
- Fervenza FC (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 6, 2014.
- Anti-PLA2R assay guidance. The Renal Association. http://rarerenal.org/clinician-information/membranous-nephropathy-clinician-information/anti-pla2r-assay-guidance/. Accessed Sept. 15, 2014.
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