Membranous glomerulonephritis

Membranous GN (diagram)

Membranous glomerulonephritis (MGN; also membranous nephropathy, MN) mainly affects middle-aged or older adults. Most often (70-80% of cases) it is a primary idiopathic autoimmune disease, 20-30% of the disease is secondary to infectious, tumor, systemic autoimmune diseases or after the administration of certain drugs^[1]. MGN is the most common cause of nephrotic syndrome in adults (20-40%), more common in men.

Microscopically we find a diffuse thickening of the glomerular capillary wall caused by the deposition of immunocomplexes into the subepithelial space (between the podocytes and the basement membrane).

Etiology[edit | edit source]

Idiopathic (primary) form of MGN (most common): Most diseases of this group are associated with the formation of autoantibodies against the M-type receptor for phospholipase A₂ (PLA2R). Some polymorphisms of the PLA2R gene in combination with some HLA-DQA1^[1] polymorphisms are associated with a high risk of this form of the disease.

Secondary form of MGN (20-30%)

infections (viral hepatitis B and C),
tumors (lung cancer, prostate cancer, hematological malignancies^[2]),
systemic autoimmune diseases (SLE),
drugs (penicillamine, gold preparations, captopril, NSA).

Clinical picture[edit | edit source]

Clinical manifestations may be unremarkable.

sudden appearance of DKK swellings + their progression
non-selective proteinuria + erythrocyturia, often fully developed nephrotic syndrome
arterial hypertension (20-40%)
impairment of renal function (at the time of dg. in 5-10%)

Video in english, definition, pathogenesis, symptoms, complications, treatment.

Therapy[edit | edit source]

Idiopathic MGN: corticoids, cyclophosphamide, chlorambucil, cyclosporine,
secondary MGN: stop precipitating drugs / treat primary disease.

Prognosis[edit | edit source]

The fundamental importance of influencing the formation of immunocomplexes,
with successful therapy, nephrotic syndrome may disappear,
many years stationary or developing CKD.

Links[edit | edit source]

Reference[edit | edit source]

↑ ^a ^b FLOEGE, Jürgen – AMANN, Kerstin. Primary glomerulonephritides. The Lancet. 2016, y. 10032, vol. 387, p. 2036-2048, ISSN 0140-6736. DOI: 10.1016/s0140-6736(16)00272-5.
↑ LEEAPHORN, Napat – KUE-A-PAI, Pogsathorn – THAMCHAROEN, Natanong. Prevalence of Cancer in Membranous Nephropathy: A Systematic Review and Meta-Analysis of Observational Studies. American Journal of Nephrology. 2014, y. 1, vol. 40, p. 29-35, ISSN 1421-9670. DOI: 10.1159/000364782.

Literature[edit | edit source]

DÍTĚ, P., et al. Vnitřní lékařství. 2. edition. Galén, 2007. ISBN 978-80-7262-496-6.

[Floege-1] FLOEGE, Jürgen – AMANN, Kerstin. Primary glomerulonephritides. The Lancet. 2016, y. 10032, vol. 387, p. 2036-2048, ISSN 0140-6736. DOI: 10.1016/s0140-6736(16)00272-5.

[2] LEEAPHORN, Napat – KUE-A-PAI, Pogsathorn – THAMCHAROEN, Natanong. Prevalence of Cancer in Membranous Nephropathy: A Systematic Review and Meta-Analysis of Observational Studies. American Journal of Nephrology. 2014, y. 1, vol. 40, p. 29-35, ISSN 1421-9670. DOI: 10.1159/000364782.

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