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This article discusses the outcomes of primary membranous nephropathy (PMN) patients who are refractory to immunosuppressants. PMN is a common cause of adult-onset nephrotic syndrome, and current guidelines recommend immunosuppressive therapy. However, a significant proportion of patients do not respond to initial treatment and require rescue therapy. The article presents a systematic review of 18 observational studies that analyzed different rescue therapies for refractory membranous nephropathy. The findings suggest that rituximab, adrenocorticotrophic hormone, and obinutuzumab show promising results, but there is no clear winner. The choice of treatment should be based on individual patient characteristics and side effect profiles. Further controlled studies are needed to investigate these agents. [Extracted from the article]

Background C3 glomerulopathy (C3G) is a heterogeneous disease caused by alternative complement pathway abnormalities without any standardized treatment. An immunosuppressive agent, mycophenolate mofetil (MMF), has been recently shown to be useful in treating C3G, mainly in studies from the west. We report the clinical outcome of 17 Indian C3G patients treated with MMF with or without steroids. Methods The clinical and histology details of the C3G patients treated with MMF for at least 6 months with a follow-up of at least 12 months were retrieved from the medical records of our center. Results The median serum creatinine and proteinuria at presentation were 0.8 mg/dL and 3.7 g/day, respectively, with the majority (88.2%) presenting as nephrotic syndrome. The mean dose of MMF was 1.65 (±0.56) g/day, and the median duration of MMF therapy was 18 months. Two-thirds (64%) of the patients responded to the treatment, with complete remission in 4 (23%) and partial remission in 7 (41%) (median time: 9 months). Three patients progressed to end-stage renal disease (ESRD) on follow-up. Of the three patients, one (33%) had an initial response in proteinuria to MMF but did not respond after a relapse and subsequently progressed to ESRD and two (67%) other patients were nonresponsive to MMF from the start of the therapy. Conclusion Despite a small sample size and lack of a control arm, this study describes the effectiveness of MMF in treating C3G patients from Asia and forms a basis for future randomized trials. [ABSTRACT FROM AUTHOR]