GLOMERULONEPHRITIS-MEMBRANOUS NEPHROPATHY

SUMMARY

1. Common cause of non-diabetic nephrotic disease. present(s) with microscopic haematuria with normal BP & renal function.

2. Causes - chronic infections (HBV), drugs (NSAIDs, penacillamine, gold), solid tumours, autoimmmune diseases, SLE.

3. Renal biopsy shows GBM subepithelial IgG and C3 deposits on immunofluorescence.

4. Patients spontaneously improve (up to 30% after 5 years), improve completely or somewhat with treatment, or progress to dialysis (14% at 5 years).

5. Patients with more severe proteinuria and/or reduced GFR have a worse prognosis, as do men > 50 yrs.

6. Highest prevalence of renal vein thrombosis. Flank pain, hematuria, and high LDH - think about renal infarction, secondary to renal vein thrombosis.

7. If severe and secondary causes are excluded, treat with corticosteroids plus a cytotoxic agent.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].