Leflunomide in idiopathic membranous nephropathy: A new immunosuppressive with promising treatment potential

摘要

Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. The term idiopathic or primary as opposed to secondary, is used when no cause can be deduced from the medical history, physical examination, or laboratory tests commonly performed to assess a patient with proteinuria. The M-type phospholipase A2 receptor (PLA_2R) was identified as an important antigenic target in the pathogenesis of IMN and the presence of circulating PLA2R antibodies was closely association with disease activity in patients with IMN. It is becoming increasingly clear and more widely accepted that IMN is an organ-specific autoimmune disease involving the kidneys. Prognosis in patients with IMN and nephrotic syndrome is more variable. Around 30% of patients develop spontaneous remission 1-2 years after diagnosis. However, 30-40% of patients progress toward end-stage renal disease (ESRD) within 5-15 years.