Membranous nephropathy

Membranous nephropathy (MN) is a chronic, immunologically mediated disease of the glomerular basement membrane that may resolve spontaneously, persist with stable renal function, or progress to kidney failure. It is one of the most common causes of nephrotic syndrome in adults.

A diagnosis of primary membranous nephropathy should only be made after secondary causes have been excluded. Definitive diagnosis is based on renal biopsy findings.

Approach to treatment is guided by risk (low, moderate, high, or very high) of progressive kidney injury.

Treatment in low-risk patients is largely conservative, including a low-sodium and low-protein diet and statins for hyperlipidemia. Hypertension is treated with ACE inhibitors or angiotensin-II receptor antagonists, and edema can be managed with the use of diuretics.

Moderate, high, and very high-risk patients may be treated with a combination of corticosteroids with either cytotoxic alkylating agents, cyclosporine, or rituximab.

MN is an immunologically mediated disease of the glomerular basement membrane that is often associated with nephrotic syndrome. It is one of the most common causes of nephrotic syndrome in the adult population. It can be described as either primary or secondary to an underlying cause.