Membranous glomerulonephritis

Question 1

What is Membranous glomerulonephritis?

Answer 1

• Membranous glomerulonephritis is the commonest type of glomerulonephritis.
• In adults and is the third most common cause of end-stage renal failure (ESRF).
• It usually presents with nephrotic syndrome or proteinuria.

Question 2

About?

Answer 2

• In flammation of the glomerulus. Often immune generated
• Change to basement membrane,mesangium or capilliary endothelium
• Antibdy mediates injury, complement cell mediated immunity

Question 3

Renal biopsy demonstrates?

Answer 3

• electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits.
• This creates a ‘spike and dome’ appearance

Question 4

Causes?

Answer 4

• idiopathic
• infections: hepatitis B, malaria, syphilis
• malignancy: lung cancer, lymphoma, leukaemia
• drugs: gold, penicillamine, NSAIDs
• autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

Question 5

Clinical?

Answer 5

• Acute onset haematuria. prteinuria and red blood cell casts
• Hypertrension, oedema and impaired renal function
• Hypertension with haedache/neurology is ominous

Question 6

Investigations?

Answer 6

• FBC - anaemia
• Urinalysis- -red cell casts, proteinuria, haematuria
• U&Es: Urea-up, Creatinine-up, K/Ca-down
• ESR/CRP up
• Blood gas: HCO3-down (metabolic acidosis)
• ANA, dsDNA, ANCA, Anti GMB, RF, Complement
• Renal biopsy

Question 7

Management?

Answer 7

• Immunosuppression: corticosteroids alone have not been shown to be effective.
• A combination of corticosteroid + another agent such as chlorambucil is often used
• Blood pressure control: ACE inhibitors have been shown to reduce proteinuria
• Consider anticoagulation