Membranous nephropathy

Question 1

Membranous glomerulonephritis is what type nephrotic or nephritis ?

Answer 1

nephrotic syndrome or proteinuria

Question 2

idiopathic Causes of Membranous glomerulonephritis

Answer 2

idiopathic: due to anti-phospholipase A2 antibodies

Question 3

infectious Causes of Membranous glomerulonephritis

Answer 3

hepatitis B, malaria, syphilis

Question 4

Membranous glomerulonephritis strongly associated with

Answer 4

cancer ! : prostate, lung, lymphoma, leukaemia, colorectal

Question 5

drug Causes of Membranous glomerulonephritis

Answer 5

gold, penicillamine, NSAIDs

Question 6

autoimmune causes of Membranous glomerulonephritis

Answer 6

systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

Question 7

diagnosis of Membranous glomerulonephritis

Answer 7

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

urine dipstick only proteinuria

Question 8

clinical features of membranous glomerulonephritis

Answer 8

frothy urine due to proteinurea
Significant pitting oedema

Question 9

high-risk patients membranous glomerulonephritis should consider ?

Answer 9

anticoagulation for high-risk patients

Question 10

mx of membranous nephropathy

Answer 10

should receive an ACE inhibitor or an angiotensin II receptor blocker (ARB):
shown to reduce proteinuria and improve prognosis
immunosuppression

many patients spontaneously improve

only patient with severe or progressive disease require immunosuppression:
corticosteroids alone not been shown to be effective.
combination of corticosteroid + another agent such as cyclophosphamide is often used

Question 11

Good prognostic features include?

Answer 11

female sex, young age at presentation and asymptomatic proteinuria

Question 12

Prognosis - rule of thirds in membranous glomerulonephritis

Answer 12

one-third: spontaneous remission
one-third: remain proteinuric
one-third: develop ESRF