Overview
Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults 2. It is characterized as a noninflammatory autoimmune glomerulonephropathy 3.Diagnosis
Management
Cyclosporine monotherapy can induce remission in patients with IMN and nephrotic syndrome 1.
Combination therapy with cyclosporine and low-dose oral corticosteroids (prednisolone 15 mg/day) may lead to a higher complete remission rate compared to cyclosporine monotherapy 1.
Rituximab has emerged as a promising alternative treatment, with overall efficacy comparable to cyclophosphamide or cyclosporine in a meta-analysis 2.
Rituximab may be more effective than cyclosporine in Asian populations but less effective than cyclophosphamide in certain contexts 2.
Astragalus membranaceus formula, when combined with supportive care or immunosuppressive therapy, may improve 24-hour urinary total protein, serum albumin, and serum creatinine, and increase complete and partial remission rates in moderate-to-high risk IMN 3.Special Populations
Key Recommendations
Combination therapy with cyclosporine and low-dose oral corticosteroids may achieve a higher complete remission rate than cyclosporine monotherapy in adult patients with biopsy-proven IMN and nephrotic syndrome 1. (Evidence: Strong)
Rituximab is an alternative treatment option for IMN with overall efficacy comparable to cyclophosphamide or cyclosporine 2. (Evidence: Moderate)
Astragalus membranaceus formula, as an adjunct to supportive care or immunosuppressive therapy, may improve proteinuria, renal function, and remission rates in moderate-to-high risk IMN 3. (Evidence: Moderate)References
1 Usui J, Hirayama K, Kobayashi M, Suzuki S, Ebihara I, Nishiki K et al.. Randomized Prospective Controlled Open-labeled Trial of Cyclosporine with/without Low-dose Oral Corticosteroids in Idiopathic Membranous Nephropathy in Adults with Nephrotic Syndrome. Internal medicine (Tokyo, Japan) 2025. link
2 Zhang Y, Chen H, Zhang H, Huang Y. Evaluating rituximab against cyclophosphamide or cyclosporine in idiopathic membranous nephropathy: a meta-analysis. European journal of medical research 2025. link
3 Wang D, Wang L, Zhang M, Li P, Zhang Q, Bao K. Astragalus membranaceus formula for moderate-high risk idiopathic membranous nephropathy: A meta-analysis. Medicine 2023. link