Membranous Glomerulonephritis

Question 1

Membranous GN is the commonest type of glomerulonephritis in adults. TRUE/FALSE?

Answer 1

TRUE

Question 2

how does membranous GN normally present?

Answer 2

• nephrotic syndrome or proteinuria.

Question 3

Membranous GN on renal biopsy electron microscopy

Answer 3

• basement membrane is thickened with subepithelial electron dense deposits

‘spike and dome’

Question 4

Causes of membranous GN

Answer 4

• idiopathic: anti-phospholipase A2 antibodies
• infections: hepatitis B, malaria, syphilis
• malignancy: prostate, lung, lymphoma, leukaemia
• drugs: gold, penicillamine, NSAIDs
• autoimmune diseases: SLE, thyroiditis, rheumatoid

Question 5

Management

Answer 5

ACEi/ARB

immunosuppression if severe/ progressive disease (steroid + cyclophosphamide)

consider anticoagulation

Question 6

Corticosteroids alone have not been shown to be effective in membranous GN. TRUE/FALSE?

Answer 6

TRUE

Question 7

Prognosis of membranous glomerulonephritis

Answer 7

1/3 = spontaneous remission
1/3 = remain proteinuric
1/3 = develop ESRF

Question 8

Good prognostic features in Membranous GN

Answer 8

• female
• young age
• asymptomatic proteinuria of a modest degree at the time of presentation