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STUDY: Look for alternatives
JOURNAL: Seminars in Nephrology
AUTHORS: Abhijit V. Kshirsagara
ABSTRACT: Despite a multitude of investigation over the last 2 decades, the treatment of membranous nephropathy remains both controversial and suboptimal.
COMMENTARY: Recent progress in the molecular pathways of inflammation and immunologic regulation holds the promise of offering futuristic alternatives and/or supplements to the standard regimen of glucocorticoids and alkylating agents.
Several potential points of intervention along the path of disease development and expression have been identified: modulation of the immune response to the pathogenetic antigen; inactivation of the inflammatory pathways responsible for B and T cell activation; blockade of pathogenetic antibody formation by B and T cells; blockade of the complement cascade; blockade of lipid peroxidation of glomerular basement membrane components; and blockade of renal fibrosis resulting from proteinuria, lipiduria, and/or inflammation.
These points of intervention form the basis of such varied potential therapies for membranous nephropathy.