Membranous glomerulonephritis is usually regarded as the commonest cause of nephrotic syndrome in the western world (although focal segmental glomerulonephritis is sometimes now regarded to have overtaken it.)
It is characterised by a thickened basement membrane on microscopy and IgG and C3 deposits on immunofluorescence.
It may be primary or secondary to:
- drugs
- captopril
- NSAIDs
- penicillamine
- gold
- clopidogrel
- mercury
- infections
- HBV
- HCV
- malaria
- schistosomiasis
- TB
- cancer
- autoimmune conditions
- RA
- SLE
Treatment
- management depends on the risk of progression
- low risk patients are managed conservatively (BP control and ACE-i)
- higher risk patients are given corticosteroids and cyclophosphamide
Prognosis
- a third remit spontaneously
- the remainder either develop persistent proteinuria or progress to chronic renal failure
