What is the role of rituximab in idiopathic membranous nephropathy?

Treatment of idiopathic membranous nephropathy (IMN) is controversial. However, two randomized controlled trials (RCTs) reported that treatment with steroids alternated with an alkylating agent achieved significantly more remissions and better renal survival at 10 years in comparison with untreated controls. Short-term RCT with other treatments also reported a high rate of remission. In a nonrandomized trial, rituximab was used in 100 patients with IMN, and obtained complete remission in 27 patients and partial remission in 38 patients after a mean follow-up of 29 months. However, four patients progressed to end-stage renal disease and four died. These results are important; however, large RCTs with long-term follow-up are needed to better evaluate the role of this expensive treatment in IMN.