Anti-TNF-α therapy in membranous glomerulonephritis

A 43-year-old woman with a history of psoriasis vulgaris was admitted for nephrotic syndrome that had started 6 months before. Renal biopsy revealed membranous glomerulonephritis (MGN). She did not receive any therapy for MGN. Two months later she started therapy for psoriasis with adalimumab, which resulted in disappearance of psoriatic skin lesions with progressive reduction of 24-h proteinuria. This is the first report of therapeutic efficacy of adalimumab in MGN. Idiopathic membranous glomerulonephritis (MGN) is the most common cause of nephrotic syndrome in adults. It is considered an autoimmune disorder in which antibodies against some antigens result in generation of immune complex with subsequent activation of the complement cascade [1]. Recently, the M-type phospholipase A2 receptor (PLA2R), expressed in podocytes, has been identified as the autoantigen [2]. Psoriasis is an immune-mediated chronic inflammatory skin disease with a strong genetic background. Chronic glomerulonephritis associated with psoriasis vulgaris has been reported in the literature [3]. However, because of the limited number of cases and the lack of specific histological findings, the pathogenetic mechanisms of these associations remain unclear [4].