Please select the eligibility criteria that correspond to the clinical trial below.
Title: Treatment of Patients With Idiopathic Membranous Nephropathy at Risk for Renal Insufficiency: Comparison of Early Versus Late Start of Immunosuppressive Therapy
Brief Summary: Patients with idiopathic membranous nephropathy at risk for renal failure can be identified in an early stage by measuring urinary low molecular weight proteins and urinary immunoglobulin G (IgG). This study evaluates the possible benefit of early start of immunosuppressive therapy in these high-risk patients.


Options:
A: Inclusion Criteria:

* Idiopathic membranous nephropathy
* Serum creatinine \< 1.5 mg/dl
* Nephrotic syndrome

Exclusion Criteria:

* Infection
* Instable angina
* Systemic disease
* Pregnancy
* Renal vein thrombosis
* Prior therapy with immunosuppressant agents
* Liver dysfunction
* Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
B: Inclusion Criteria:

* Adult HBV-GN patients with biopsy-proven MN, heavy protinuria, HBsAg or HBeAg positive, HBV-DNA negative

Exclusion Criteria:

* Primary MN patients, HBV-DNA positive
C: Inclusion Criteria

* Idiopathic MN with diagnostic biopsy
* Female, must be post-menopausal, surgically sterile or practicing a medically approved method of contraception(no birth-control pill)
* Must be off prednisone or mycophenolate mofetil for \>1 month and alkylating agents for \>6 months.
* angiotensin-converting-enzyme inhibitor (ACEi) and/or Angiotensin II receptor blockers (ARB), for \>3 months prior to randomization and adequate blood pressure (target BP \<130/80 millimeter of mercury (mmHg) in \>75% of the readings, but subjects with BP \<140/80 mmHg in \>75% of the readings will be eligible). Patients with documented evidence of \>3 months treatment with maximal angiotensin II blockade, on an 3-hydroxy-3-methylglutaryl-CoA lyase (HMG-CoA) reductase inhibitor, and BP control (BP \<140/80 mmHg in \>75% of the readings) who remain with proteinuria \>5g/24h may enter and be randomized to RTX/CSA without the need of the run-in/conservative phase of the study.
* Proteinuria \>5g/24h on two 24-hour urine collection collected within 14 days of each other
* Estimated glomerular filtration rate (GFR) ≥40 ml/min/1.73m2 while taking ACEi/ARB therapy OR quantified endogenous creatinine clearance \>40 ml/min/1.73m2 based on a 24-hour urine collection.

Exclusion Criteria

* Presence of active infection or a secondary cause of MN (e.g. hepatitis B, systemic lupus erythematosus (SLE), medications, malignancies). Testing for HIV, Hepatitis B and C should have occurred \<2 years prior to enrollment into the study.
* Type 1 or 2 diabetes mellitus: to exclude proteinuria secondary to diabetic nephropathy. Patients who have recent history of steroid induced diabetes but no evidence on renal biopsy performed within 6 months of entry into the study are eligible for enrollment.
* Pregnancy or breast feeding for safety reasons
* History of resistance to CSA (or other calcineurin inhibitors, e.g. tacrolimus), RTX or alkylating agents (e.g. Cytoxan). Patients who previously responded to CSA/Calcineurin Inhibitor (CNI), RTX or alkylating agents with either a complete remission (CR) or partial remission (PR) but relapsed off CSA/CNI after 3 months or relapsed off RTX or alkylating agent after 6 months are eligible.
D: Inclusion Criteria:

* At least 18 years old.
* Idiopathic Membranous nephropathy proved by renal biopsy
* Persistent urinary protein excretion rate ≥3,5g/24 h and albuminemia \< 30g/l for at least 6 months with full dose of NIST
* Patient receiving a non immunosuppressive conventional treatment (antiproteinuric and antihypertensive blocking the rennin-angiotensine system, lipid-lowering statin) since at least 6 months.
* Patient has given its written consent
* Patient with social coverage (excepting AME)
* Use of an efficient contraception method for women in childbearing age.

Exclusion Criteria:

* Secondary membranous nephropathy
* Patient already in a clinical trial
* Patient received an immunosuppressive treatment within 3 months before the study
* Patient with chronic renal disease defined by estimated GFR by MDRD formula under 30ml/mn/1,73m²
* Pregnancy and breastfeeding
* HIV infection, HCV and HBV active infection
* Severe or evolving infections.
* Allergy or hypersensitivity to Rituximab or any component

Answer: A