Membranous nephropathy: diagnosis, treatment, and monitoring in the post-PLA2R era

Luisa Safar-Boueri, Albina Piya, Laurence H. Beck, Rivka Ayalon*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations

Abstract

Membranous nephropathy (MN) is an immune complex-mediated cause of the nephrotic syndrome that can occur in all age groups, from infants to the very elderly. However, nephrotic syndrome in children is more frequently caused by conditions such as minimal change disease or focal segmental glomerulosclerosis, and much less commonly by MN. While systemic conditions such as lupus or infections such as hepatitis B may more commonly be associated as secondary causes with MN in the younger population, primary or “idiopathic” MN has generally been considered a disease of adults. Autoantibodies both to the M-type phospholipase A2 receptor (PLA2R) and to thrombospondin type-1 domain-containing 7A (THSD7A), initially described in adult MN, have now been identified in children and adolescents with MN and serve as a useful diagnostic and monitoring tool in this younger population as well. Whereas definitive therapy for secondary forms of MN should be targeted at the underlying cause, immunosuppressive therapy is often necessary for primary disease. Rituximab has been successfully used in the treatment of MN, and is likely effective in children with MN as well, although dosing in the pediatric population is not well established. This review highlights the new findings in adult and pediatric MN since last reviewed in this journal.

Original languageEnglish (US)
Pages (from-to)19-30
Number of pages12
JournalPediatric Nephrology
Volume36
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • Autoimmunity
  • Membranous nephropathy
  • Nephrotic syndrome
  • Phospholipase A2 receptor (PLA2R)
  • Thrombospondin type-1 domain-containing 7A (THSD7A)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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