Membranous Nephropathy When Second-Line Immunosuppressive Therapy Has Failed

This protocol covers the clinical situation in membranous nephropathy where second-line immunosuppressive therapy has not produced an adequate response, and further escalation is required.

Previous Treatment — Failure Condition

The prior line employed cyclophosphamide or rituximab as second-line therapy. Escalation to this protocol is indicated when proteinuria response and anti-PLA2R antibody levels (decreasing) have not been achieved — with antibody response assessed at 3 months when rituximab was chosen.

Next Step — Partial Overview

At this stage, referral to a specialist centre is the key intervention. That centre may evaluate options beyond those used in standard second-line management. The full protocol specifies the scope of that evaluation and what it may entail.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.kint.2021.05.015

Patients who did not respond to rituximab or cyclophosphamide should have a consultation with an expert center.

These centers may choose experimental therapies (bortezomib, anti-CD38 therapy, and belimumab) or a higher dose of conventional immunosuppressive therapy.

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