Current Therapeutic Strategies for Idiopathic Membranous Nephropathy

Introduction: Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults. It is an immune-mediated disease characterized by subepithelial immune complex deposition and alterations in the glomerular basement membrane. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend, for the treatment of this serious public health problem, rituximab or cyclophosphamide with steroids, or calcineurin inhibitor–based therapy. However, it is necessary to evaluate the efficacy of the currently proposed therapies. Methods: A search was conducted in the PubMed (MEDLINE) database using the MeSH terms “Glomerulonephritis, Membranous” and “Therapeutics,” applying the filters “Systematic Reviews” and “Free full text.” Studies published between 2020 and 2024 were selected, totaling 13 articles. Results: Rituximab proved to be effective, well-tolerated, and safe in the treatment of IMN, with the added advantage of being steroid-free. Most patients achieved complete remission during the follow-up period, with low rates of adverse events and relapses. Treatment with Tripterygium wilfordii poly-glycosides showed improvements, observed through essential markers for assessing renal function, such as 24-hour urinary protein levels, with significant clinical remission. Additionally, tacrolimus, both as monotherapy and combined with steroids, demonstrated a strong therapeutic effect in achieving overall and complete remission. However, the relapse rate with monotherapy was higher than with established therapies such as cyclophosphamide plus corticosteroids. Conclusions: IMN is a serious disease and a significant health problem for both patients and healthcare systems. In this context, rituximab therapies have shown high efficacy. Moreover, treatments with tacrolimus and Tripterygium wilfordii poly-glycosides have demonstrated potential effectiveness in treating IMN, as evidenced by renal function markers and good clinical remission, highlighting the need for further studies to ensure the safety and efficacy of these alternative therapies.