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Membranous nephropathy

Last reviewed: 6 Sep 2024
Last updated: 24 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • edema
  • elevated BP
Full details

Other diagnostic factors

  • incidental proteinuria or abnormal renal function
  • xanthelasma
  • foamy urine
  • fatigue/malaise
  • anorexia
  • Muehrcke lines
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • urinalysis
  • urine protein to creatinine ratio
  • serum BUN
  • serum creatinine
  • creatinine clearance
  • serum albumin
  • lipid profile
Full details

Tests 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
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Manish Suneja, MD, FASN, FACP

Professor

Department of Internal Medicine

Division of Nephrology

University of Iowa Hospitals and Clinics

Iowa City

IA

Disclosures

MS receives royalties from McGraw-Hill as an editor of the book DeGowin's Diagnostic Examination.

Acknowledgements

Professor Manish Suneja would like to gratefully acknowledge Dr Aash Bhatt, a previous contributor to this topic.

Disclosures

AB declares that he has no competing interests.

Peer reviewers

Ajay Kumar, MD, FACP

Medical Director

Blood Management

Cleveland Clinic

Cleveland

OH

Disclosures

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

London

UK

Disclosures

GN declares that he has no competing interests.

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  • Guidelines

    • KDIGO clinical practice guideline for glomerulonephritis​
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