原发性膜性肾病的免疫抑制治疗OA

Primary membranous nephropathy(PMN)is a leading cause of nephrotic syndrome in adults.The discovery of antibodies against phospholipase A2 receptor(PLA2R)has ushered in the era of biomarker-based diagnosis and therapeutic monitoring for PMN.The cornerstone of immunosuppressive therapy lies in risk stratification based on proteinuria levels,renal function,and dynamic changes in anti-PLA2R antibody titers,enabling individualized timing of treatment initiation with the dual goals of achieving both immunological and clinical remission.This article systematically reviews the initiation timing,first-line therapeutic options—inclu-ding cyclophosphamide combined with corticosteroids,calcineurin inhibitors,and anti-CD20 monoclonal anti-bodies—and key considerations for follow-up and relapse management in PMN,integrating evidence-based find-ings with clinical practice to inform individualized decision-making.