This document summarizes a presentation on membranous nephropathy (MN). The presentation discusses: 1) The pathogenesis and pathology of MN, focusing on its autoimmune nature. 2) Immunosuppression treatments for MN including calcineurin inhibitors (CNIs), rituximab, and newer therapies. 3) Algorithms and guidelines for the management and treatment of MN. 4) Recent 2019 clinical studies on treatments like rituximab and CNIs. 5) Recurrent MN after kidney transplantation. 6) The use of circulating anti-PLA2R antibody levels to diagnose and monitor MN noninvasively.

1. Membranous Nephropathy
GN Master Class, Monday, 22 October, 2019
Hussein Sheashaa, MD, FACP
Professor of Nephrology, Urology and Nephrology Center and Director of
Medical E-Learning Unit, Mansoura University, ESNT-CME Chair and Executive
Director of ESNT- Virtual Academy: http://lms.mans.edu.eg/esnt/

4. 1. Pathogenesis and pathology
2. Immunosuppression
3. Algorithms
4. 2019 clinical studies
5. Recurrent MN
6. Closing
Focus of The Talk

6. Annu Rev Pathol. 2019 Oct 17, in press
Membranous Nephropathy:
Pathogenesis

7. Membranous Nephropathy:
Autoimmunity
Kidney International (2019), in press

8. Membranous Nephropathy:
Pathogenesis

9. Membranous Nephropathy:
Histopathology

10. 1. Pathogenesis and pathology
2. Immunosuppression
3. Algorithms
4. 2019 clinical studies
5. Recurrent MN
6. Closing
Focus of The Talk

11. Nat Rev Nephrol. 2017 Sep;13(9):563-579
Membranous Nephropathy:
Treatment

12. Tacrolimus for MN
The cumulative partial or complete remission
were 50%, 63% and 67% at 6, 12 and 24 months,
respectively, and the cumulative complete
remission rates were 4%, 13% and 23%.
Relapse rate 37.3%

13. Kidney Int Rep (2017) 2, 610–616
n 70 RCT
Remission rate
Tacrolimus for MN

14. CNI for MN

15. J Am Soc Nephrol 28: 2729–2737, September 2017
Rituximab for MN
retrospective, observational cohort study

16. J Am Soc Nephrol 28: 348–358, 2017
Rituximab for MN

17. J Am Soc Nephrol 28: 348–358, 2017
proteinuria serum albumin
anti–PLA2R-Ab levels
Rituximab for MN

18. Kidney International (2017) 92, 227–237
Rituximab for MN:
T-reg and Response

19. BMC Nephrology (2017) 18:44
Rituximab for MN:
MGH Protocol

20. Membranous Nephropathy:
Treatment
Clin J Am Soc Nephrol 12: 983–997, June, 2017
PLA2R peptides
peptide-blocking agents
newer complement inhibitors
New monoclonal antibodies and small interfering RNA agents

21. BMC Nephrology (2017) 18:104
Outcome Predictors

22. 1. Pathogenesis and pathology
2. Immunosuppression
3. Algorithms
4. 2019 clinical studies
5. Recurrent MN
6. Closing
Focus of The Talk

23. Lancet 2015; 385: 1983–92
Management of MN:
Search for Secondary MN

24. Clin J Am Soc Nephrol 12: 983–997, June, 2017
Management of MN:
Search for Secondary MN

25. Clin J Am Soc Nephrol 13: 784–786, 2018.
Management of MN:
Value of anti-PLA2R and PLA2R

26. Proposed Categorization of
Membranous Nephropathy
Kidney International (2019) 95, 268–280

27. Secondary MN
Case Rep Nephrol Dial 2019;9:79–84

28. Int J Biol Markers. 2019 Oct 16, in press
Secondary MN

29. Secondary MN

30. Secondary MN

31. Clin J Am Soc Nephrol 12: 983–997, June, 2017
Management of MN:
Algorithm Map

32. Clin J Am Soc Nephrol 12: 983–997, June, 2017
Management of MN:
Algorithm Map

33. Clin J Am Soc Nephrol 12: 983–997, June, 2017
Management of MN:
Algorithm Map

34. Management of MN:
Algorithm Map

35. PLoS One. 2019 Sep 9;14(9):e0221293
Management of MN:
Algorithm Map

36. Management of MN:
Value of circulating levels of anti-PLA2R

37. BMC Nephrol. 2019 Sep 18;20(1):360.
Management of MN:
Value of circulating levels of anti-PLA2R
11 trials involving 824 patients

38. Clin J Am Soc Nephrol 13: 784–786, 2018.
Management of MN:
Value of circulating levels of anti-PLA2R

39. Noninvasive Diagnosis of
MN
Kidney International (Feb 2019) 95, 268–280

40. Noninvasive Diagnosis of
MN
Kidney International (Feb 2019) 95, 429–438

41. Clin J Am Soc Nephrol 13: 784–786, 2018.
Management of MN:
Value of circulating levels of anti-PLA2R

42. Clin J Am Soc Nephrol 13: 784–786, 2018.
Management of MN:
Value of circulating levels of anti-PLA2R

43. IMN:
Anti-PLA2R-IgG4
Kidney Blood Press Res Published online: June 26, 2019

44. PLA2R-Negative MN
and IgG4-RD

45. 1. Pathogenesis and pathology
2. Immunosuppression
3. Algorithms
4. 2019 clinical studies
5. Recurrent MN
6. Closing
Focus of The Talk

46. CNI for MN

47. PLA2R1-Related Membranous
Nephropathy: High-Dose Rituximab

48. PLA2R1-Related Membranous
Nephropathy: High-Dose Rituximab
CJASN ePress. Published on July 24, 2019

49. Rituximab bioavailability in
Membranous Nephropathy
Nephrol Dial Transplant (August 2019) 34: 1423–1425

50. N Engl J Med. 2019 Jul 4;381(1):36-46
Treatment of MN:
Rituximab Vs CsA

51. Membranous Nephropathy:
2019 MENTOR-based Shift

52. Rituximab?

53. Resistant IMN:
Role of ACTH
Kidney Int. 2019 Jul;96(1):250-251

54. Membranous Nephropathy:
Effects of LDL-A
Therapeutic Apheresis and Dialysis 2019, in press

55. Membranous Nephropathy:
Immunoadsorption

56. 1. Pathogenesis and pathology
2. Immunosuppression
3. Algorithms
4. 2019 clinical studies
5. Recurrent MN
6. Closing
Focus of The Talk

57. Curr Opin Nephrol Hypertens 2017, 26:501–508
Recurrent MN

58. Clinical Kidney Journal, 2018, vol. 11, no. 3, 422–428
Recurrent MN

59. Membranous Nephropathy
Posttransplantation

60. 1. Pathogenesis and pathology
2. Immunosuppression
3. Algorithms
4. 2019 clinical studies
5. Recurrent MN
6. Closing
Focus of The Talk

61. Management of MN:
Thromboembolism

62. Membranous Nephropathy:
anti-PLA2R Antibody

64. ESNT Virtual Academy:
http://lms.mans.edu.eg/esnt/
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21 October 2019