DOI: 10.1016/j.ekir.2019.09.005; PMCID: PMC6895579
Introduction: The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for Glomerulonephritis recommend that patients with membranous nephropathy (MN) at risk for progression receive immunosuppressive therapy (IST), usually after 6 months of observation. A cyclophosphamide (CYC) or calcineurin inhibitor (CNI)-based regimen is recommended as first-line IST. However, the extent to which KDIGO recommendations are adopted in practice remains largely unknown.
Methods: We evaluated prescribing practice among patients with primary MN (diagnosed 2010-2018) enrolled in the Cure Glomerulonephropathy Network (CureGN) cohort study. We also evaluated the availability of testing for phospholipase A2 receptor (PLA2R) in the contemporary era.
Results: Among 361 patients (324 adults and 37 children) with MN who were IST-naïve at biopsy and had at least 6 months of follow-up, 55% of adults and 58% of children initiated ISTthese, 1 in 5 had no indication for (i.e., urine protein-to-creatinine ratio [uPCR] < 4 g/g) or an apparent contraindication to (i.e., an estimated glomerular filtration rate [eGFR]
Conclusion: These findings suggest that providers are not aware of, or lack confidence in, current KDIGO guidelines for MN. Treatment patterns observed in this cohort might critically inform the drafting of planned updates to KDIGO guidelines.
Kidney Int Rep
immunosuppression; membranous nephropathy; treatment patterns
O'Shaughnessy MM, Troost JP, Bomback AS, et al. Treatment Patterns Among Adults and Children With Membranous Nephropathy in the Cure Glomerulonephropathy Network (CureGN). Kidney Int Rep. 2019;4(12):1725-1734. Published 2019 Sep 16. doi:10.1016/j.ekir.2019.09.005