Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- edema
- pressão arterial (PA) elevada
Other diagnostic factors
- proteinúria incidental ou função renal anormal
- xantelasma
- urina espumosa
- fadiga/mal-estar
- anorexia
- linhas de Muehrcke
Risk factors
- sexo masculino
- idade >40 anos
- HLA-DR3
- doença autoimune
- hepatites B e C
- sífilis
- carcinoma de órgão sólido
- medicações
- sarcoidose
- pós-transplante renal
Diagnostic tests
1st tests to order
- urinálise
- relação proteína/creatinina na urina
- ureia sérica
- creatinina sérica
- clearance da creatinina
- albumina sérica
- perfil lipídico
Tests to consider
- 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
Treatment algorithm
todos os pacientes
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.
References
Key articles
Couser WG. Primary Membranous Nephropathy. Clin J Am Soc Nephrol. 2017 Jun 7;12(6):983-997.Full text Abstract
Ronco P, Beck L, Debiec H, et al. Membranous nephropathy. Nat Rev Dis Primers. 2021 Sep 30;7(1):69.Full text Abstract
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.Full text Abstract
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. Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Glomeruloesclerose e segmentar focal
- Doença de lesão mínima
- Glomerulonefrite mesangioproliferativa
More DifferentialsGuidelines
- KDIGO clinical practice guideline for glomerulonephritis
- Chronic kidney disease: assessment and management
More GuidelinesPatient information
Doença renal crônica: quais tratamentos funcionam?
Doença renal crônica: o que é?
More Patient informationCalculators
Taxa de filtração glomerular estimada pela equação de estudo em MDRD rastreável por IDMS
More Calculators
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer