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INTRODUCTION: Immunosuppressive treatment of patients with idiopathic membranous nephropathy (IMN) is debated due to its possible side effects. The 2012 KDIGO guidelines suggest alkylating agents as first choice therapy. The aim of the study is to retrospectively evaluate the induction and maintenance of clinical remission in patients with histological diagnosis of IMN undergoing steroid and/or cyclosporine therapy at the Nephrology Unit of the Sant'Andrea Hospital in Rome. MATERIALS AND METHODS: Therapy A (conservative) was reserved to low-risk patients. 8 medium and high risk patients were induced by Therapy B (Prednisone 1 mg / kg ≤12-16 weeks plus 8 weeks withdrawal); 6 patients by Therapy C (Prednisone 1 mg /kg ≥20-24 weeks plus 8 week withdrawal) and, finally, 6 steroid-resistent patients by Therapy D (steroid withdrawal + cyclosporine 3-5 mg / kg for 2 years). RESULTS: Complete remission was observed in 37.5% of patients in Therapy B, in 83.3% of patients in Therapy C and in 66.6% of patients in Therapy D. Patients in group B relapsed more frequently than patients in the other groups. Side effects were irrelevant. CONCLUSIONS: In view of the potential cytotoxicity of alkylating agents, steroids are a valid alternative in inducing and maintaining clinical remission over time, when administered with a more aggressive induction scheme. In cases of steroid resistance or rapid relapse, cyclosporine is a valid alternative to alkylating agents.

Autoantibody against phospholipase A2 receptor (anti-PLA2R) is a sensitive and specific biomarker of idiopathic membranous nephropathy (iMN), being found in approximately 70% of iMN patients and only occasionally in other glomerular diseases. However, whereas its diagnostic specificity vs. normal controls and other glomerulonephritides (GN) has been firmly established, its specificity vs. membranous nephropathy associated with various diseases (sMN) has given inconsistent results. The aim of our study was to evaluate the prevalence of anti-PLA2R antibodies in iMN in comparison with various control groups, including sMN. A total of 252 consecutive iMN patients, 184 pathological and 43 healthy controls were tested for anti-PLA2R antibody using indirect immunofluorescence (PLA2R IIFT, Euroimmun). Anti-PLA2R autoantibodies were detectable in 178/252 iMN patients, 1/80 primary GN, 0/72 secondary GN, 9/32 sMN and 0/43 healthy controls, with a diagnostic sensitivity of 70.6%. The diagnostic specificity of anti-PLA2R antibody vs. normal and pathological controls was 100 and 94.6% respectively. However, when the diagnostic specificity was calculated only vs. secondary forms of MN, it decreased considerably to 71.9%. Interestingly enough, 9 out of 10 anti-PLA2R positive patients in the disease control groups had membranous nephropathy associated with various diseases (7 cancer, 1 Crohn’s disease, 1 scleroderma). In conclusion, anti-PLA2R positivity in a patient with MN, should not be considered sufficient to abstain from seeking a secondary cause, especially in patients with risk factors for neoplasia. The causal relationship between tumors and anti-PLA2R-induced MN remains to be established, as well as the possible mechanisms through which malignancies provoke autoimmunity.

Objective: Assess response to Ponticelli scheme in patients with idiopathic membranous nephropathy.Barranquilla 2011-2013. Materials and methods: Analytical study type clinical trial in 21 patients with idiopathic membranous nephropathy confirmed by renal biopsy who underwent treatment according Ponticelli scheme ; were performed 24h-proteinuria, creatinine, creatinine clearance and type IV blood count at the beginning , during routine follow-up, and 6 months after completion of the scheme. Results: On admission, the mean proteinuria was 7.46 ± 4.15 g/24 hr and at six months was 1.93 ± 1.55 g/24 hr; creatinine at baseline was 1.43 ± 0.88 mg/dl and 1.33 ± finish the scheme 0.82 mg/dl ; complete remission was achieved in 23.8 % , partial response in 66.7 % and no therapeutic response at 9.5% is present. Conclusions: The implementation of the scheme Ponticelli produced marked diminution of proteinuria, and total or partial therapeutic response in most patients, both considered good prognostic factor in nephrotic syndrome; however, due to disagreement with some studies, such as Ponticelli , and adverse effects , is necessary to continue research in this field, Objetivo: Evaluar la respuesta al esquema Ponticelli en pacientes con nefropatía membranosa idiopática Barranquilla 2011-2013. Materiales y Métodos: Estudio analítico tipo ensayo clínico en 21 pacientes con nefropatía membranosa idiopática confirmados por biopsia renal en quienes se realizó tratamiento según esquema Ponticelli; se les realizó proteinuria en 24 horas, creatinina, depuración de creatinina y hemograma tipo IV, al inicio, durante los controles de seguimiento y a los 6 meses después de haber finalizado el esquema. Resultados: Al ingresar, la media de la proteinuria fue 7,46 ± 4,15 gr/24 hr y a los seis meses fue de 1,93 ± 1,55 gr/24 hr; la creatinina al inicio fue 1,43 ± 0,88 mg/dl y al terminar el esquema 1,33 ± 0,82 mg/dl; se logró remisión total en el 23,8%, remisión parcial en el 66,7% y no se presento respuesta terapéutica en el 9,5%. Conclusiones: La aplicación del esquema Ponticelli produjo marcada diminución de la proteinuria, y respuesta terapéutica total o parcial en la mayoría de los pacientes, ambos considerados factor de buen pronóstico en el síndrome nefrótico, no obstante, debido a la discrepancia con algunos estudios, como el de Ponticelli, es necesario continuar la investigación en este campo.