Highlighter is on. Drag to highlight text. Click a highlight to remove it.
ALL / Nephrology

Membranous glomerulonephritis

Membranous glomerulonephritis

Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF). It usually presents with nephrotic syndrome or proteinuria.

Causes
  • idiopathic: due to anti-phospholipase A2 antibodies
  • infections: hepatitis B, malaria, syphilis
  • malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
  • drugs: gold, penicillamine, NSAIDs
  • autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

Diagnosis
  • anti-PLA2R antibodies → positive in ~70–80% of idiopathic membranous nephropathy
  • screen for secondary causes:
    • hepatitis B, C, HIV
    • SLE (ANA, anti-dsDNA)
    • malignancy (esp. solid tumours: lung, colon, breast)
    • drugs (NSAIDs, gold, penicillamine)
  • renal biopsy is needed for a definite diagnosis:
    • electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance

Management
  • all patients should receive an ACE inhibitor or an angiotensin II receptor blocker (ARB):
    • these have been shown to reduce proteinuria and improve prognosis
  • immunosuppression
    • as many patients spontaneously improve only patient with severe or progressive disease require immunosuppression
    • corticosteroids alone have not been shown to be effective. A combination of corticosteroid + another agent such as cyclophosphamide is often used
  • consider anticoagulation for high-risk patients

Prognosis - rule of thirds
  • one-third: spontaneous remission
  • one-third: remain proteinuric
  • one-third: develop ESRF

Good prognostic features include female sex, young age at presentation and asymptomatic proteinuria of a modest degree at the time of presentation.

Silver-stained section showing thickened basement membrane, subepithelial spikes
+PassMedicine Notes

Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF). It usually presents with nephrotic syndrome or proteinuria.

Causes
  • idiopathic: due to anti-phospholipase A2 antibodies
  • infections: hepatitis B, malaria, syphilis
  • malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
  • drugs: gold, penicillamine, NSAIDs
  • autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
Diagnosis
  • anti-PLA2R antibodies → positive in ~70–80% of idiopathic membranous nephropathy
  • screen for secondary causes:
    • hepatitis B, C, HIV
    • SLE (ANA, anti-dsDNA)
    • malignancy (esp. solid tumours: lung, colon, breast)
    • drugs (NSAIDs, gold, penicillamine)
  • renal biopsy is needed for a definite diagnosis:
    • electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance
Management
  • all patients should receive an ACE inhibitor or an angiotensin II receptor blocker (ARB):
    • these have been shown to reduce proteinuria and improve prognosis
  • immunosuppression
    • as many patients spontaneously improve only patient with severe or progressive disease require immunosuppression
    • corticosteroids alone have not been shown to be effective. A combination of corticosteroid + another agent such as cyclophosphamide is often used
  • consider anticoagulation for high-risk patients
Prognosis - rule of thirds
  • one-third: spontaneous remission
  • one-third: remain proteinuric
  • one-third: develop ESRF

Good prognostic features include female sex, young age at presentation and asymptomatic proteinuria of a modest degree at the time of presentation.



Saved ✓

MEDIA