Personalized Medicine for Membranous Nephropathy

Inclusion Criteria:

• Age 18 years or more

• Anti-PLA2R1 activity detected by ELISA or Euroimmune Immunofluorescence Assay

• Nephrotic syndrome defined by proteinuria > 3.5 g/24h (or UPCR > 3.5 g/g) and serumalbumin < 30 g/L at diagnosis

• eGFR (CKD-EPI) > 30 ml/min/1,73 m2 at diagnosis

• Symptomatic treatment according to KDIGO guidelines: maximal tolerated dose of NIAT : Non Immunosuppressive Antiproteinuric Treatment (angiotensin-converting enzymeinhibitor and/or angiotensin 2 receptor blockers, diuretics and statins)

• Medical insurance

• Signed informed consent

• Having understood and accepted the need for long-term medical follow-up

• Woman of child-bearing age must be using an effective method of contraception

Exclusion Criteria:

• Secondary Membranous Nephropathy: Membranous Nephropathy related to cancer,infectious, systemic lupus erythematosis, drug

• Anti-PLA2R1 antibodies not confirmed by central analysis (in this case the patientwill be replaced)

• Pregnancy or breastfeeding

• Immunosuppressive treatment in the 3 last months

• Cancer under treatment

• Patient with complicated nephrotic syndrome that would require earlyimmunosuppressive treatment (thrombosis, acute renal failure...)

• Patients with active, severe infections or active hepatitis B

• Hypersensitivity to the active substance or to murine proteins, or to any of theother excipients

• Patients in a severely immunocompromised state

• Severe heart failure (New York Heart Association Class IV) or severe, uncontrolledcardiac disease

• Patients unable to give an informed consent