• Membranous Glomerulonephritis (G.N) accounts for about 45% of nephrotic syndrome in adults.
• If occurs in old age, search for malignancy.
• Chronic Renal Failure CRF can occur within 5-10 yrs.
• Characterized by heavy proteinuria + ++ incidence of renal vein thrombosis.
Causes:
(pathogenesis most likely in situ immune complex)
1. Primary
2. Secondary to:
- SLE - hepatitis B - malaria (Plasmodium malariae) - gold - penicillamine - captoril - Neoplasm of lung, stomach or breast.
Microscopic examination :
- Thick basement membrane due to deposition of immune complex)
- Light: Thick basement membrane.
- E/M: More details (Thick basement membrane & subepithelial spikes).
- Immunofluorescence: Ig G - C3
• Patients with moderate proteinuria as above with no response to the above therapy or patients with proteinuria > 8 gm/d with or without diminished GFR may be treated with combination of corticosteroids and chlorambucil for 6 months period or with cyclosporine. This treatment may cause remission and decrease the incidence of chronic renal failure.
remission, while another 25% experience a partial remission (proteinuria < 2gm but> 200 mg/D). These patients may maintain a stable GFR for decades.
• If occurs in old age, search for malignancy.
• Chronic Renal Failure CRF can occur within 5-10 yrs.
• Characterized by heavy proteinuria + ++ incidence of renal vein thrombosis.
Causes:
(pathogenesis most likely in situ immune complex)
1. Primary
2. Secondary to:
- SLE - hepatitis B - malaria (Plasmodium malariae) - gold - penicillamine - captoril - Neoplasm of lung, stomach or breast.
Clinical Picture of Membranous Glomerulonephritis
Nephrotic syndrome : HereMicroscopic examination :
- Thick basement membrane due to deposition of immune complex)
- Light: Thick basement membrane.
- E/M: More details (Thick basement membrane & subepithelial spikes).
- Immunofluorescence: Ig G - C3
Treatment of Membranous Glomerulonephritis
• In patients with mild proteinuria < 4 gm/d or with moderate proteinuria (4-8 gm/day) with normal GFR we can give just conservative treatment i.e. diuretics, ACE inhibitors to reduce proteinuria and to control blood pressure with observation for either spontaneous remission or progression.• Patients with moderate proteinuria as above with no response to the above therapy or patients with proteinuria > 8 gm/d with or without diminished GFR may be treated with combination of corticosteroids and chlorambucil for 6 months period or with cyclosporine. This treatment may cause remission and decrease the incidence of chronic renal failure.
Prognosis of Membranous Glomerulonephritis
• 50 % of patients develop chronic renal failure, 25 % have completeremission, while another 25% experience a partial remission (proteinuria < 2gm but> 200 mg/D). These patients may maintain a stable GFR for decades.