Please select the eligibility criteria that correspond to the clinical trial below.
Title: Prospective Randomized Multicentric Open Label Study to Evaluate Rituximab Treatment for Idiopathic Membranous Nephropathy (IMN)
Brief Summary: The Membranous Nephropathy is one of the most common cause of Nephrotic Syndrome of adults. In 2/3 of patients the cause of the disease is idiopathic. This can also be referred to as idiopathic membranous nephropathy (IMN).The most of these patients are treated by non immunosuppressive symptomatic treatment (NIST): antiproteinuric and antihypertensive blocking the rennin-angiotensine system. However, the patients resistant to antiproteinuric treatment risk to develop an end stage renal disease (ESRD).

Rituximab has been recently used in patients suffering of nephrotic syndrome related to IMN in four international studies. Rituximab appears effective and safe in reducing proteinuria in nearly 60% of patients.

The primary outcome of the investigators prospective randomized study is to determine whether or not the Rituximab associated with NIST is more effective than non immunologic symptomatic treatment alone in inducing long term remission of proteinuria.


Options:
A: 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
B: Inclusion Criteria:

1. Biopsy-proven diagnosis of idiopathic MN performed within the past 24 months
2. Proteinuria \> 3.5 g/24h on three 24-hour urine collection (once a week for 3 weeks)
3. Estimated GFR (MDRD formula) ≥ 30ml/min/1.73m2 under ACEI/ARB therapy
4. Post-menopausal females, or females surgically sterile or practicing a medically approved method of contraception (no birth-control pill)
5. Three months of ACEI and/or ARB therapy before treatment
6. Blood Pressure \<130/80 mm Hg
7. HMG-CoA reductase inhibitor therapy
8. Patients remaining with proteinuria \>3.5g/24h after 3 months of ACEI and/or ARB therapy and Blood Pressure \<130/80 mm Hg may be randomized to RTX / cyclical corticosteroid/alkylating-agent therapy without the need of the run-in/conservative phase of the study.

Exclusion Criteria:

1. serum creatinine \>2.5 mg/dl; Estimated GFR \< 30 ml/min/1.73m2
2. previous treatment with Rituximab, Steroids, Alkylating Agents, Calcineurin Inhibitors, Synthetic ACTH, MMF, Azathioprine
3. Presence of active infection
4. Secondary cause of MN (e.g. hepatitis B, SLE, medications, malignancies). Testing for HIV, Hepatitis B and C should have occurred \< 6 months prior to enrollment into the study
5. Type 1 or 2 diabetes mellitus
6. Pregnancy or nursing for safety reasons
7. Renal vein thrombosis documented prior to entry by renal US or CT scan
C: 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
D: Inclusion Criteria:

1. Patients with idiopathic membranous nephropathy
2. The duration of disease is less than twelve months
3. Patients with persistent proteinuria more than 8 grams per day
4. Patients who provided informed consent
5. The cases that satisfy more than three of following items even if proteinuria is less than 8 grams per day:

   * eGFR \< 60 ml/min/1.73m2
   * Hypertension (BP above 140/90mmHg or BP above 120/80 in patients taking anti-hypertensive agents)
   * 24 hours urine protein or spot urine protein/creatinine ratio \> 5.0 g/day
   * Serum albumin (g/dL) \< 3.0
   * Selectivity index \> 0.2

Exclusion Criteria:

1. Severe digestive organ disease
2. Allergy history to clinical trial medication and acute or chronic allergy for 4 weeks recently.
3. Clinical history of treatment with other immunosuppressive medication
4. Probability of pregnancy, breast feeding woman
5. Uncontrolled hypertension (more than 160/100mmHg)
6. Uncontrolled systemic disease
7. Drug addiction or alcoholics within 6 months
8. eGFR is less than 30ml/min at screening
9. Abnormal liver function test (more than 3 times above compared with normal value)
10. Absolute neutrophil count \<1,500/mm3 or leukocyte \<2,500/mm3 or platelets \<100,000/mm3
11. Secondary membranous nephropathy
12. Expected life expectancy is less than 1 year

Answer: A