Nefropatia membranosa
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presença de fatores de risco
- edema
- pressão arterial (PA) elevada
Otros factores de diagnóstico
- proteinúria incidental ou função renal anormal
- xantelasma
- urina espumosa
- fadiga/mal-estar
- anorexia
- linhas de Muehrcke
Factores de riesgo
- sexo masculino
- idade >40 anos
- HLA-DR3
- doença autoimune
- hepatites B e C
- sífilis
- carcinoma de órgão sólido
- medicações
- sarcoidose
- pós-transplante renal
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- urinálise
- relação proteína/creatinina na urina
- ureia sérica
- creatinina sérica
- clearance da creatinina
- albumina sérica
- perfil lipídico
Pruebas diagnósticas que deben considerarse
- testes da função hepática séricos ou plasmáticos
- sorologia para hepatite B e C
- fator antinuclear, anti-DNA de fita dupla
- níveis do complemento
- anti-SS-B e anti-SS-A
- autoanticorpos anti-PLA2R
- domínios anti-Trombospondina tipo 1 - contendo autoanticorpos 7A (THSD7A)
- ultrassonografia renal com Doppler da artéria renal
- biópsia renal
Algoritmo de tratamiento
todos os pacientes
Colaboradores
Autores
Manish Suneja, MD, FASN, FACP
Professor
Department of Internal Medicine
Division of Nephrology
University of Iowa Hospitals and Clinics
Iowa City
IA
Раскрытие информации
MS receives royalties from McGraw-Hill as an editor of the book DeGowin's Diagnostic Examination.
Выражение благодарностей
Professor Manish Suneja would like to gratefully acknowledge Dr Aash Bhatt, a previous contributor to this topic.
Раскрытие информации
AB declares that he has no competing interests.
Рецензенты
Ajay Kumar, MD, FACP
Medical Director
Blood Management
Cleveland Clinic
Cleveland
OH
Раскрытие информации
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
Раскрытие информации
GN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Couser WG. Primary Membranous Nephropathy. Clin J Am Soc Nephrol. 2017 Jun 7;12(6):983-997.Полный текст Аннотация
Ronco P, Beck L, Debiec H, et al. Membranous nephropathy. Nat Rev Dis Primers. 2021 Sep 30;7(1):69.Полный текст Аннотация
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021 Oct;100(4s):S1-S276.Полный текст Аннотация
Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria, and the progression of renal disease. The modification of diet in renal disease study. Ann Intern Med. 1995 Nov 15;123(10):754-62. Аннотация
von Groote TC, Williams G, Au EH, et al. Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome. Cochrane Database Syst Rev. 2021 Nov 15;11(11):CD004293.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Glomeruloesclerose e segmentar focal
- Doença de lesão mínima
- Glomerulonefrite mesangioproliferativa
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