Membranous nephropathy

Membranous nephropathy (MN), also called membranous glomerulonephritis, is pathologically characterized by diffuse subepithelial immune-complex deposition with diffuse basement membrane thickening, clinically presenting as nephrotic syndrome (NS) or asymptomatic proteinuria.

Common Symptoms

Rheumatoid arthritis; lower-limb edema; hematuria; urine protein; nephrotic syndrome; proteinuria

Causes

1. Immune diseases: SLE, rheumatoid arthritis, diabetes, Hashimoto thyroiditis, Graves disease, mixed connective tissue disease, Sjögren, primary biliary cirrhosis, ankylosing spondylitis, acute infectious polyneuritis. 2. Infection: hepatitis B and C, syphilis, leprosy, filariasis, schistosomiasis, malaria. 3. Drugs/toxins: organic gold, mercury, D-penicillamine, captopril, probenecid. 4. Tumors: lung, colon, breast, lymphoma. 5. Others: sarcoidosis, recurrent transplant, sickle cell disease, Kimura disease; but 75% have none of these, i.e. primary MN. Mechanism: circulating or in situ immune complexes; in 1980 Salant and Couser showed complement activation (C5b-9 MAC) is required in passive Heymann nephritis; the MAC inserts into epithelial cell membranes, releases oxygen radicals, degrades type IV collagen and increases permeability; probucol reduced proteinuria by 85%. Epithelial cells secrete cytokines, MMP-9/TIMP, fibrinolytic factors, TGF, PDGF, EGF; increased extracellular matrix mediated by TGF-β2 thickens the basement membrane.

Treatment

Medication, supportive treatment

Prevention

1. Rest, low-protein diet, vitamins, avoid nephrotoxic drugs. 2. Revisit every 1-2 weeks. 3. Repeat renal biopsy. 4. Protect residual renal function. Treat infection, thrombosis (albumin <20 g/L), and acute renal failure.

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.