Membranous glomerulonephritis

Membranous glomerulonephritis clinically presents mainly as massive proteinuria or nephrotic syndrome, pathologically as uniform thickening of the glomerular capillary basement membrane with diffuse subepithelial immune-complex deposition and no marked cell proliferation. It clinically presents as nephrotic syndrome (NS) or asymptomatic proteinuria.

Common Symptoms

Decreased urine osmolality; glomerulosclerosis; markedly decreased filtration fraction; hematuria; low plasma albumin; dyslipidemia

Causes

Etiology. Idiopathic membranous nephropathy is about 50% of adult nephrotic syndrome; secondary causes must be excluded. In patients over 60, about 22% have malignancy, and malignancy-related nephritis is most often membranous (60%-70%): tumors of lung, breast, GI tract, ovary, renal cell, lymphoma, leukemia, sarcoidosis. Associated diseases: diabetes, sarcoidosis, thyroiditis, myasthenia gravis, sickle cell anemia, ITP, polyarteritis nodosa, pyoderma gangrenosum, bullous pemphigoid. Drugs: penicillamine, gold, captopril. Autoimmune: Sjögren, SLE, mixed connective tissue disease. Infection antigens and parasites: malaria, schistosomiasis. Hepatitis B-associated GN and HCV membranous nephropathy. Mechanism: chronic slow subepithelial immune-complex deposition; the terminal complement components C3b-C9 (membrane attack complex) damage the basement membrane without obvious inflammation; immunofluorescence shows granular IgG and C3. Immune dysregulation and genetic markers (HLA-DR3 in Europeans, HLA-DR2 in Japanese) are associated.

Treatment

Medication, symptomatic treatment, supportive treatment

Prevention

1. Rest, avoid fatigue, prevent infection, low-protein diet, vitamins, avoid nephrotoxic drugs. 2. Revisit every 1-2 weeks during drug therapy. 3. Repeat renal biopsy after control. 4. Protect residual renal function. Treat complications: (1) infection: use sensitive potent non-nephrotoxic antibiotics; (2) thrombosis: when albumin <20 g/L start prophylactic anticoagulation for over half a year; (3) acute renal failure: treat promptly.

Recommended Department

It is recommended to visit the nephrology department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.