Effectiveness of treatment and management of membranous glomerulonephritis in adult patients
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Publicación 5. Vol 6. Num 4. (Español (España))
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Published:
Oct 5, 2023
Keywords:
Membranous glomerulonephritis, Primary membranous nephropathy, Nephrotic syndrome,
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Abstract
Introduction. Membranous glomerulonephritis (MGN) is a chronic renal pathology that affects the glomeruli, which are the structures responsible for filtering the blood in the kidneys. Timely treatment and proper management of membranous nephropathy in adult patients are essential to improve the quality of life of patients. Objective. To describe the most effective therapeutic approaches and the factors that can influence the response to treatment for early diagnosis and management of membranous glomerulonephritis. Methodology. A descriptive narrative study was conducted through systematic data collection, in which a representative sample of scientific research relevant to the treatment and management of the disease was selected during the period 2019-2023. Results. Treatment of membranous glomerulonephritis in low-risk patients is based on the use of ARA II or IECA to control blood pressure and reduce proteinuria, with the aim of reducing by 20% the rate of recurrence of the disease. If there is not a response to therapy, more aggressive options are available, such as the immunosuppressive treatment itself, which increases total remission by 73% and reduces the risk of developing terminal kidney disease by 22%. Conclusion. The effectiveness of therapy for membranous glomerulonephritis is based on the combination of steroid-based immunosuppressive therapy with chlorambucil or cyclophosphamide to prevent poor treatment tolerance by the nephrotic patient and decrease the relapses of membrane nephropathy.
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Gahona Bravo, M. L., & Santiago Bueno, A. (2023). Effectiveness of treatment and management of membranous glomerulonephritis in adult patients. ConcienciaDigital, 6(4), 145-175. https://doi.org/10.33262/concienciadigital.v6i4.2699
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References
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Coronel G, B. A. (Abril de 2023). Caracterización y tratamiento de los pacientes diagnosticados con Glomerulonefritis Membranosa en adultos. (1a ed.). Quito: Facultad de Ciencia Médicas. Retrieved 18 de Mayo de 2023.
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Ponticelli C, P. M. (2021). Calcineurin Inhibitors in Membranous Nephropathy. 6(10), 2537-2539. Kidney Int Rep. Retrieved 20 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484501/pdf/main.pdf
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Rojas J, O. A. (2021). Nefropatía membranosa primaria en la era de los autoanticuerpos y de las terapias biológicas. Medicina Clínica, 157(3), 121-129.
Rojas-Rivera, J. F. (2022). Recent Clinical Trials Insights into the Treatment of Primary Membranous Nephropathy. 82(2), 109-132. Drugs. Retrieved 20 de mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8844164
Ronco P, B. L. (2021). Membranous Nephropathy. 7(1), 69-92. Nature Reviews Disease Primers . Retrieved 21 de Mayo de 2023, from https://pubmed.ncbi.nlm.nih.gov/34593809/
Ronco P, P. E. (2021). Advances in Membranous Nephropathy. 10(4), 607-625. Retrieved 23 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915386/
S., S. (2021). New 'Antigens' in Membranous Nephropathy. 32(2), 268-278. J Am Soc Nephrol. Retrieved 21 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054892/
SanMartin C, V. C. (2022). Manejo de la nefropatía membranosa idiopática con ciclofosfamida endovenosa. Rev Repert Med Cir, 31(2). ScienceDirect.
Sethi S, B. J. (2019). Exostosin 1/Exostosin 2–Associated Membranous Nephropathy. Journal of the American Society of Nephrology, 30(6).
Taherkhani A, F. R. (2019). Chronic Kidney Disease: A Review of Proteomic and Metabolomic Approaches to Membranous Glomerulonephritis, Focal Segmental Glomerulosclerosis, and IgA Nephropathy Biomarkers. Proteome Science, 17(1). Retrieved 2019, from Stanford Medicine: https://www.stanfordchildrens.org/es/topic/default?id=glomerulonefritis-90-P06178
Teisseyre M, C. M. (2022). Advances in the Management of Primary Membranous Nephropathy and Rituximab-Refractory Membranous Nephropathy. 13(1), 859419. Retrieved 22 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9114510/
Thompson A, C. K. (2019). Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy. Clin J Am Soc Nephrol, 14(3), 469-81. Retrieved 22 de Mayo de 2023, from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419287/
Torres R, R. C. (2021). Abordaje clínico y diagnóstico de la glomerulonefritis membranoproliferativa, reporte de caso. Rev Colomb Nefrol , 7(2).
Von Groote T, W. G. (2021). Immunosuppressive Treatment for Primary Membranous Nephropathy in Adults with Nephrotic Syndrome. Cochrane Database of Systematic Reviews, 11(11). Retrieved 5 de Octubre de 2020, from Nefrología al día: https://nefrologiaaldia.org/es-articulo-fisiologia-renal-335
Wu Lianzhong, L. J. (2021). A Review of the Current Practice of Diagnosis and Treatment of Idiopathic Membranous Nephropathy in China. 27(1), 930097. Med Sci Monit. Retrieved 21 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876949/pdf/medscimonit-27-e930097.pdf
Yang, Y.-z. C. (2019). Comparison of the Effects of Hydroxychloroquine and Corticosteroid Treatment on Proteinuria in IgA Nephropathy: A Case-Control Study. BMC Nephrology, 20(1), 297. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683466/
Alsharhan Loulwa, B. L. (2021). Membranous Nephropathy: Core Curriculum 2021. Revista, 77(3), 440-453. Am J Kidney Dis. Retrieved 22 de Mayo de 2023, from https://www.ajkd.org/action/showPdf?pii=S0272-6386%2820%2931133-1
Berchíd Débdi, S. (2019). Ecografía renal en atención primaria. Med fam Andal, 20(1), 55-70.
Caravaca-Fontán, F. F. (2023). Future Landscape for the Management of Membranous Nephropathy. Clinical Kidney Journal, 16(8), 1228-1238. Retrieved 22 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387398/
Carracedo J, R. R. (2020). Fisiología Renal. Sociedad Española de Nefrología , 17(5). Retrieved 17 de Mayo de 2023, from Kenhub: https://www.kenhub.com/es/library/anatomia-es/rinon-histologia
Chávez A, F. M. (2019). Protocolo diagnóstico y tratamiento de la nefropatía lúpica. Medicine - Programa de Formación Médica Continuada Acreditado, 12(82).
Coronel G, B. A. (Abril de 2023). Caracterización y tratamiento de los pacientes diagnosticados con Glomerulonefritis Membranosa en adultos. (1a ed.). Quito: Facultad de Ciencia Médicas. Retrieved 18 de Mayo de 2023.
Cueto, A. M. (2019). La Sociedad Latinoamericana de Nefrología e Hipertensión y los retos de la enfermedad renal crónica en nuestra región. Nefrología Latinoamericana , 16((1)). Retrieved 2019, from Orphanet: https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=ES&Expert=97560
D. Rodríguez Puyol, & P. Martínez Miguel. (Mayo de 2019). Glomerulopatías. Medicine - Programa de Formación Médica Continuada Acreditado, 12(80).
Dhaouadi T, A. J. (2020). PLA2R Antibody, PLA2R rs4664308 polymorphism and PLA2R mRNA levels in Tunisian patients with primary membranous nephritis. PLOS ONE, 15(10), e0240025. Retrieved 23 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529277/pdf/pone.0240025.pdf
Fervenza F, A. G. (2019). Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy. 381(1), 36-46. N Engl J Med. Retrieved 20 de Mayo de 2023, from https://pubmed.ncbi.nlm.nih.gov/31269364/
Gordón, P. (2019). ANÁLISIS DE UN CASO CLÍNICO DE GLOMERULONEFRITIS MEMBRANOSA EN UNA MUJER DE 41 AÑOS DIAGNOSTICADO EN EL HOSPITAL GENERAL LATACUNGA.
Goździk M, P. A. (2019). Acute Kidney Injury Following Exposure to Calcineurin Inhibitors in a Patient with Idiopathic Membranous Nephropathy. Drug Safety , 6(1).
Kidney Disease: Improving Global Outcomes Glomerular Disease Work Group. (Jan de 2021). KDIGO 2020 clinical practice guideline for glomerular diseases. Kidney Int , 100(1). Retrieved 25 de Junio de 2023, from Mayo Clinic: https://www.mayoclinic.org/es/tests-procedures/kidney-biopsy/about/pac-20394494
Krishna CK, B. S. (2019). Primary Membranous Nephropathy: Comprehensive Review and Historical Perspective. Postgrad Med J, 95(1119).
Maifata, H. Z. (2019). Primary Membranous Glomerulonephritis: The Role of Serum and Urine Biomarkers in Patient Management. 7(4), 86-100. Biomedicines. Retrieved 18 de mayo de 2023, from https://www.mdpi.com/2227-9059/7/4/86
Moroni G, P. C. (2020). Secondary Membranous Nephropathy. A Narrative Review. Front Med , 7(1).
Ottati D, S. M. (2022). Nefropatía Membranosa. En G. Liliana, & G. Liliana (Ed.), Guías de práctica clínica en el tratamiento de las glomerulopatías (1 ed., Vol. 1). Uruguay: Cuadrado Montevideo. Retrieved 23 de Mayo de 2023.
Pertuz A, C. J. (2022). Glomerulonephritis: an Approach to the KDIGO 2021 Guidelines. 18(7), 1552-1563. Retrieved 18 de Mayo de 2023.
Ponticelli C, P. M. (2021). Calcineurin Inhibitors in Membranous Nephropathy. 6(10), 2537-2539. Kidney Int Rep. Retrieved 20 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484501/pdf/main.pdf
Rivera F, A. S. (2020). Síndromes Clinicos en Nefrología. Sociedad Española de Nefrología, 258(1). Retrieved 30 de Enero de 2023, from Infobae: https://www.infobae.com/noticias/2023/01/30/nefropatia-membranosa-causas-sintomas-y-tratamiento/
Rojas J, O. A. (2021). Nefropatía membranosa primaria en la era de los autoanticuerpos y de las terapias biológicas. Medicina Clínica, 157(3), 121-129.
Rojas-Rivera, J. F. (2022). Recent Clinical Trials Insights into the Treatment of Primary Membranous Nephropathy. 82(2), 109-132. Drugs. Retrieved 20 de mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8844164
Ronco P, B. L. (2021). Membranous Nephropathy. 7(1), 69-92. Nature Reviews Disease Primers . Retrieved 21 de Mayo de 2023, from https://pubmed.ncbi.nlm.nih.gov/34593809/
Ronco P, P. E. (2021). Advances in Membranous Nephropathy. 10(4), 607-625. Retrieved 23 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915386/
S., S. (2021). New 'Antigens' in Membranous Nephropathy. 32(2), 268-278. J Am Soc Nephrol. Retrieved 21 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054892/
SanMartin C, V. C. (2022). Manejo de la nefropatía membranosa idiopática con ciclofosfamida endovenosa. Rev Repert Med Cir, 31(2). ScienceDirect.
Sethi S, B. J. (2019). Exostosin 1/Exostosin 2–Associated Membranous Nephropathy. Journal of the American Society of Nephrology, 30(6).
Taherkhani A, F. R. (2019). Chronic Kidney Disease: A Review of Proteomic and Metabolomic Approaches to Membranous Glomerulonephritis, Focal Segmental Glomerulosclerosis, and IgA Nephropathy Biomarkers. Proteome Science, 17(1). Retrieved 2019, from Stanford Medicine: https://www.stanfordchildrens.org/es/topic/default?id=glomerulonefritis-90-P06178
Teisseyre M, C. M. (2022). Advances in the Management of Primary Membranous Nephropathy and Rituximab-Refractory Membranous Nephropathy. 13(1), 859419. Retrieved 22 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9114510/
Thompson A, C. K. (2019). Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy. Clin J Am Soc Nephrol, 14(3), 469-81. Retrieved 22 de Mayo de 2023, from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419287/
Torres R, R. C. (2021). Abordaje clínico y diagnóstico de la glomerulonefritis membranoproliferativa, reporte de caso. Rev Colomb Nefrol , 7(2).
Von Groote T, W. G. (2021). Immunosuppressive Treatment for Primary Membranous Nephropathy in Adults with Nephrotic Syndrome. Cochrane Database of Systematic Reviews, 11(11). Retrieved 5 de Octubre de 2020, from Nefrología al día: https://nefrologiaaldia.org/es-articulo-fisiologia-renal-335
Wu Lianzhong, L. J. (2021). A Review of the Current Practice of Diagnosis and Treatment of Idiopathic Membranous Nephropathy in China. 27(1), 930097. Med Sci Monit. Retrieved 21 de Mayo de 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876949/pdf/medscimonit-27-e930097.pdf
Yang, Y.-z. C. (2019). Comparison of the Effects of Hydroxychloroquine and Corticosteroid Treatment on Proteinuria in IgA Nephropathy: A Case-Control Study. BMC Nephrology, 20(1), 297. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683466/