MANAGEMENT OF MEMBRANOUS GLOMERULONEPHRITIS-EFFICACY OF MYCOPHENOLATE MOFETIL: A CASE REPORT AND LITERATURE REVIEW

Idiopathic membranous glomerulonephritis (MGN) is a leading cause of nephrotic syndrome in adults and is associated with a significant risk of progression to end-stage renal disease. While immunosuppressive agents such as cyclophosphamide and rituximab are commonly used, their long-term use is limited by substantial side effects. Mycophenolate mofetil (MMF), a more tolerable immunosuppressant, has demonstrated promising efficacy in other glomerular diseases, though its role in idiopathic MGN remains underexplored. We report the case of a 55-year-old male with biopsy-proven stage II idiopathic MGN, who showed no improvement on angiotensin receptor blocker therapy. Due to deteriorating renal function, a second biopsy was performed, revealing lupus-like histologic features despite a negative immunologic workup. MMF combined with low-dose prednisone was initiated, leading to a sustained remission over an 8-year period, with stable renal function and marked reduction in proteinuria. Relapses occurred following discontinuation of MMF, underscoring its therapeutic importance. A third biopsy confirmed persistent idiopathic MGN, with no secondary cause identified. Although not currently recommended by KDIGO guidelines for idiopathic MGN, MMF may offer an effective and steroid-sparing alternative to conventional regimens. This case highlights the potential of MMF as a long-term treatment option with good efficacy and tolerability, particularly for patients with contraindications to standard immunosuppressive therapies.