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Membranous Glomerulonephritis causes, diagnosis, treatment, prognosis

• 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.

Clinical Picture of Membranous Glomerulonephritis

Nephrotic syndrome : Here

Microscopic examination :
- Thick basement membrane due to deposition of immune complex)
- Light: Thick basement membrane.
- E/M: More details (Thick basement membrane & subepithelial spikes).
Membranous-Glomerulonephritis

- 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 complete
remission, while another 25% experience a partial remission (proteinuria < 2gm but> 200 mg/D). These patients may maintain a stable GFR for decades.
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Tamer Mobarak

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