Table 2.

Possible treatment choices in patients with idiopathic (primary) membranous nephropathy

Treatment	Results	Notes
Steroids alone	No benefit	Although ineffective, frequently used by practitioner
Steroids-alkylating agents	Can significantly increase the probability of complete or partial remission. Protect renal function in the long term	The results are confirmed by randomized controlled trials. Risk of side effects (infection, leucopenia). Avoid frequent repetitions (risk of oncogenic or gonadotoxic effects)
CNI	Can significantly reduce the amount of proteinuria and increase the probability of complete or partial remission. Little information about their effects on renal function	Relapse of proteinuria is frequent after CNI withdrawal. Risk of hypertension, nephrotoxicity. Little information about long-term safety
Mycophenolate salts	Ineffective when given alone. Can reduce proteinuria when given together with steroids	Only small-sized studies with short-term follow-up are available. High relapse rate. No information about the long-term safety and efficacy
ACTH	Can reduce proteinuria	Only few small-sized studies with short-term follow-up are available. A randomized controlled trial is in progress
Rituximab	Can reduce proteinuria	Large observational studies available. No head-to- head comparison with other treatments

CNI, calcineurin inhibitors; ACTH, adrenocorticotropic hormone.