Is Obinutuzumab the Answer to Primary Membranous Nephropathy Resistant to Rituximab?

Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in nondiabetic adults worldwide.Historically, patients that needed immunosuppression were treated with cytotoxic drugs or calcineurin inhibitors, which were effective but associated with a significant risk of toxicity long-term.The treatment landscape changed after the seminal work by Remuzzi et al. in 2002 reporting on the successful use of rituximab in 8 patients with MN.[1] Since then, a number of studies have documented the efficacy of rituximab in inducing proteinuria remission in MN, [2] (see supplemental references) with up to 80% of the patients