In primary membranous nephropathy, optimal supportive and antiproteinuric care is the established first step for all patients. When that approach does not lead to spontaneous remission by around six months, a structured escalation is indicated.
The preceding step — optimal supportive care with maximal antiproteinuric (conservative) therapy — targeted spontaneous remission: decreasing proteinuria and a rising serum albumin, assessed at approximately 6 months. Failure to reach those targets is the condition that escalates to this protocol.
At this stage, management moves to immunosuppressive therapy. The choice among available options is guided by the individual patient's risk estimate for disease progression — the full algorithm and the complete set of options are in the protocol.
The targets are complete or partial remission, reflected by decreasing proteinuria, rising serum albumin, and disappearance of anti-PLA2R antibodies — with complete immunologic remission defined by anti-PLA2R below 2 RU/ml by ELISA. Response is evaluated at 6 months after the start of therapy.
DOI: 10.1016/j.kint.2021.05.015