Research advances of factors and mechanisms for therapeutic efficacy of rituximab for primary membranous nephropathy

Primary membranous nephropathy （PMN） is a kidney-specific autoimmune disease mediated by autoantibodies. Although rituximab （RTX） has been widely applied as a first-line treatment for PMN, 20%-40% patients are non-responsive to RTX. High disease activity, severe renal lesions and low RTX bioavailability may be correlated with poor therapeutic response to RTX. Residual B cells in tissues, preservation of CD20 negative B cells, epitopic spreading, disorders of T cells and cytokines are potential mechanisms of RTX-refractory PMN. Elucidation of these factors and potential mechanisms shall help to boost the efficacy of RTX for PMN.