COMMENTARY

Treating Membranous Nephropathy: Pieces in the Puzzle

Lynda Szczech, MD, MSCE

Disclosures

May 03, 2013

In This Article

Immunosuppression for Progressive Membranous Nephropathy

The Study

Howman A, Chapman TL, Langdon MM, et al. Immunosuppression for progressive membranous nephropathy: a UK randomised controlled trial. Lancet. 2013;381;744-751.

Background

Did you ever notice that the American Society of Nephrology and National Kidney Foundation meeting sessions on updates in the treatment of glomerulonephritis are always standing-room only? Given the relative infrequency of these diagnoses, the hunger of most nephrologists for more information on these topics is notable.

When I see people standing in the back and on the sides of these large rooms, eager to hear clear directions on how best to treat these patients, I am reminded of my first idiopathic membranous diagnosis as a new attending physician fresh out of training in 1997. I asked the nephrologists with whom I worked how they treated membranous nephropathy and got the response, "If you're American, you use cyclophosphamide, but if you're European, you use chlorambucil." As I read the Lancet article on the UK membranous nephropathy trial,[1] I thought of that moment and realized how little the answers to that question have changed in 16 years.

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