Treatments and drugs

By Mayo Clinic Staff

Treatment focuses on addressing the cause of your disease and relieving your symptoms. There is no cure.

In cases where the disease is caused by a medication or another disease (such as a tumor), stopping the medication or controlling the other disease will usually improve your condition.

Conservative therapy

In general, the first step to control the loss of protein by the kidney is conservative treatment. This consists of:

  • Controlling your blood pressure with the help of medications that block the angiotensin II system, such as angiotensin-converting enzyme (ACE) inhibitors
  • Decreasing swelling (edema) with water pills (diuretics), which help remove sodium and water from your blood
  • Controlling your cholesterol levels with the help of statin medications
  • Reducing the amount of protein in your diet

Research has shown that as many as 30 percent of people with membranous nephropathy have a complete resolution of symptoms (remission) over several years without any treatment, and 10 to 30 percent have a partial remission. Doctors generally want to avoid using strong drugs, which have side effects, early in the course of the disease, when there's a chance that the disease will improve on its own.

If your urine protein level remains less than 4 grams a day and creatinine clearance remains normal for a six-month follow-up period, you are considered low risk. Creatinine is a waste product filtered from the blood by the kidney. You have only a small risk of developing serious kidney disease over five years.

Higher protein levels, higher risk

More intensive treatment is considered if the amount of protein in your urine increases. The more protein you have in your urine, the greater the risk to your health.

You are considered at moderate risk if your urine protein level stays between 4 and 8 grams a day with creatinine clearance at normal or near normal over six months of observation. About half the people with these symptoms develop serious kidney disease over five years.

You are considered high risk if the protein in your urine is greater than 8 grams a day and persists over the following months or if your kidney function is either below normal or decreases during the observation period. People with these symptoms have a high risk of progressing to serious kidney disease over five years.

If your proteinuria is getting worse, you may be prescribed drugs to suppress your immune system, such as a calcineurin inhibitor, or a combination of corticosteroids with a chemotherapy drug. (Corticosteroids alone rarely work in people with membranous nephropathy.) These drugs are effective in reducing urine protein levels and stopping the progress toward kidney failure. But they have significant side effects, they don't help everyone, and symptoms return for many people after treatment ends. Some of the side effects of chemotherapy drugs — such as risk of bladder cancer, leukemia and infertility — occur long term and may not be noticeable at the time of the treatment.

People who don't respond to a first course of immunosuppression therapy or who relapse may benefit from a second course of treatment.

A drug called rituximab (Rituxan) has shown effectiveness in people who have not benefited from immunosuppressive therapy. The drug kills B cells in the immune system. They are the cells that produce the antibodies that damage the glomeruli. However, use of this drug is still experimental and rituximab is expensive and not generally covered by insurance plans.

Oct. 12, 2011

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