{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T16:42:16Z","timestamp":1781196136752,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2015,11,9]],"date-time":"2015-11-09T00:00:00Z","timestamp":1447027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Even though current treatment guidelines for idiopathic membranous glomerulonephritis (<jats:styled-content style=\"fixed-case\">iMGN<\/jats:styled-content>) exist, many questions regarding an optimal therapy remain unanswered. Complete remission cannot be achieved in all patients; relapses occur, in some cases frequently, and side effects from the immunosuppressive therapy are common. Therapeutic options in high\u2010risk patients not responding to standard immunosuppressive therapies are limited. Recent research reveals that the human M\u2010type phospholipase A<jats:sub>2<\/jats:sub> receptor (<jats:styled-content style=\"fixed-case\">PLA<\/jats:styled-content><jats:sub>2<\/jats:sub>R) is a causative factor in <jats:styled-content style=\"fixed-case\">iMGN<\/jats:styled-content> that parallels clinical disease activity. However, in some patients, this correlation is not evident and additional undetermined factors seem to play a role.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We evaluated a new rescue protocol including plasma exchanges (<jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>) against albumin, intravenous immunoglobulins (<jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content>s) and rituximab for 10 patients with a biopsy\u2010proven diagnosis of <jats:styled-content style=\"fixed-case\">iMGN<\/jats:styled-content> who were therapy\u2010resistant to all conventional regimens and had a urinary protein to creatinine ratio of more than 10 000 mg\/g Crea. We compared this protocol with standard immunosuppressive protocols including monthly alternating prednisolone plus cyclophosphamide (18 patients), cyclosporine plus prednisolone (23 patients) and rituximab alone (eight patients) in a retrospective design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our rescue regimen with <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> IVIG<\/jats:styled-content>s and rituximab achieved partial remission in 90% of patients who had been otherwise refractory to therapy. The mean time to partial remission was 2\u00b71 months. Furthermore, two anti\u2010<jats:styled-content style=\"fixed-case\">PLA<\/jats:styled-content><jats:sub>2<\/jats:sub>R\u2010antibody negative patients were also treated with this rescue regimen, achieving partial remission after 1 and 4 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A combination of <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> IVIG<\/jats:styled-content>s and rituximab is a treatment option to consider for high\u2010risk patients with <jats:styled-content style=\"fixed-case\">iMGN<\/jats:styled-content> who are refractory to conventional therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.12545","type":"journal-article","created":{"date-parts":[[2015,10,8]],"date-time":"2015-10-08T01:22:59Z","timestamp":1444267379000},"page":"1260-1269","source":"Crossref","is-referenced-by-count":34,"title":["A new rescue regimen with plasma exchange and rituximab in high\u2010risk membranous glomerulonephritis"],"prefix":"10.1111","volume":"45","author":[{"given":"Janina","family":"M\u00fcller\u2010Deile","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Schiffer","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Hiss","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Haller","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Schiffer","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp665"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp254"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2010.01.008"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.41.936"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfg616"},{"key":"e_1_2_8_7_1","first-page":"139","article-title":"Kidney disease: improving global outcomes [KDIGO] Glomerulonephritis Work Group. 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