Membranous nephropathy

Last reviewed: 1 Mar 2023
Last updated: 24 Jan 2023



History and exam

Key diagnostic factors

  • edema
  • elevated BP
More key diagnostic factors

Other diagnostic factors

  • incidental proteinuria or abnormal renal function
  • xanthelasma
  • foamy urine
  • fatigue/malaise
  • anorexia
  • Muehrcke lines
Other diagnostic factors

Risk factors

  • male sex
  • age >40 years
  • HLA-DR3
  • autoimmune disease
  • hepatitis B and C
  • syphilis
  • solid organ carcinoma
  • medications
  • sarcoidosis
  • postrenal transplantation
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine protein to creatinine ratio
  • serum BUN
  • serum creatinine
  • creatinine clearance
  • serum albumin
  • lipid profile
More 1st investigations to order

Investigations to consider

  • serum or plasma LFTs
  • hepatitis B and C serology
  • antinuclear antibody, antidouble-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
More investigations to consider

Treatment algorithm


all patients



Manish Suneja, MD, FASN, FACP


Department of Internal Medicine

Division of Nephrology

University of Iowa Hospitals and Clinics

Iowa City



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.

Peer reviewers

Ajay Kumar, MD, FACP

Medical Director

Blood Management

Cleveland Clinic




AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from 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.

  • Differentials

    • Focal segmental glomerulosclerosis
    • Minimal change disease
    • Mesangioproliferative glomerulonephritis
    More Differentials
  • Guidelines

    • KDIGO clinical practice guideline for glomerulonephritis​
    • KDIGO clinical practice guideline for glomerulonephritis
    More Guidelines
  • Patient leaflets

    Chronic kidney disease: what is it?

    Chronic kidney disease: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer