A chronic immunologically mediated disease of the glomerular basement membrane that may resolve spontaneously, persist with stable renal function, or progress to end-stage renal failure. One of the most common causes of nephrotic syndrome in adults.
A diagnosis of idiopathic membranous nephropathy should only be made after secondary causes have been excluded. A renal biopsy is required for definitive diagnosis.
Approach to treatment is based on risk (low, medium, or high) of progression of renal disease.
Treatment in low-risk patients is largely conservative, including a low-sodium and low-protein diet and statins for hyperlipidaemia. Hypertension is treated with ACE inhibitors or angiotensin II receptor antagonists, and oedema can be managed with the use of diuretics.
Medium- and high-risk patients may be treated with a combination of corticosteroids with either cytotoxic agents or ciclosporin.
Membranous nephropathy 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 idiopathic (primary) or secondary to an underlying cause.
History and exam
- serum or plasma LFTs
- hepatitis B and C serology
- ANA, anti-double-stranded DNA
- complement levels
- anti-SS-B, anti-SS-A
- anti-PLA2R autoantibodies
- anti-Thrombospondin type 1 domain–containing 7A (THSD7A) autoantibodies
- renal ultrasound with renal artery Doppler study
- renal biopsy
Manish Suneja, MD, FASN, FACP
Department of Internal Medicine
Division of Nephrology
University of Iowa Hospitals and Clinics
MS receives royalties from McGraw-Hill as an editor of the book DeGowin's Diagnostic Examination.
Professor Manish Suneja would like to gratefully acknowledge Dr Aash Bhatt, a previous contributor to this topic. AB declares that he has no competing interests.
Ajay Kumar, MD, FACP
AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from medscape.com for the education webcast of the same presentation.
Guy Neild, MD, FRCP, FRCPath
Professor of Nephrology
Institute of Urology and Nephrology
University College London
GN declares that he has no competing interests.
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