Evaluation of Immunotherapy for Idiopathic Membranous Nephropathy Based on Risk Stratification and Pathological Stage

Background: The treatment options for idiopathic membranous nephropathy (IMN) based on risk stratification and pathological staging remains unclear. Methods: This prospective cohort study included patients over 18 years with biopsy-proven, estimated glomerular filtration rate > 50 mL/min/1.73m2 IMN patients, as well as selecting IMN patients at medium and high risk in the KDIGO guidelines, with pathological stage II and III, and treated with tacrolimus (TAC), rituximab (RTX) or cyclophosphamide (CYC). Low risk patients were divided into supportive care (SC) and non-SC (NSC) groups. Results: The incidence of complete remission (CR) was significantly higher in the TAC group than in the RTX and CYC groups in medium risk group at 12 months (P = 0.045). In high risk group, the CR rate was 48.0%, 35.6%, and 16.7% in TAC, CYC, and RTX groups, respectively (P < 0.001), and the average time to CR was the shortest in TAC group (P = 0.008). In stage II group, TAC group had a higher CR rate and shorter average time to CR (P = 0.001, P = 0.015, respectively). For low risk, the mean proteinuria in NSC group was remarkably lower than SC group at 6 months (P = 0.035), however, the overall remission rate was similar between the groups. Conclusion: Compared with RTX and CYC groups, TAC exhibited a higher rate of CR in moderate and high risk groups, and had a higher incidence of CR and a shorter average time to CR in the stage II group.