Membranous Glomerulonephritis Clinical Presentation

  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: May 10, 2012
 

History

  • Onset is insidious.
  • Approximately 80% of patients describe edema.
  • Patients may present with nonspecific complaints of anorexia, malaise, and fatigue.
  • Some patients may present with asymptomatic proteinuria.
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Physical

  • The overwhelming majority of patients have edema or generalized anasarca. Hypertension may be present but is not characteristic of the disease in its early stages. This is unlike most other renal diseases, which are associated with significant hypertension.
  • Ascites and pericardial and pleural effusions are uncommon, unless the nephrotic syndrome is severe.
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Causes

Causes of membranous nephropathy can be idiopathic or secondary. Often, distinguishing between idiopathic and secondary causes is not possible based on clinical evidence alone. In secondary membranous nephropathy, such as lupus and hepatitis, concomitant mesangial or subendothelial deposits may be present. De novo membranous glomerulopathy (DNMG) can develop post transplant. This can be in the context of a donor-specific alloantibody (DSA) directed against HLA DQ7.[5]

  • Autoimmune diseases
    • Ankylosing spondylitis
    • Dermatomyositis
    • Graves disease
    • Hashimoto disease
    • Mixed connective-tissue disease
    • Rheumatoid arthritis
    • Sjögren syndrome
    • Systemic lupus erythematosus: Of patients with lupus nephritis, 10-20% have membranous nephropathy.
    • Systemic sclerosis
  • Infectious diseases
    • Enterococcal endocarditis
    • Filariasis
    • Hepatitis B: This occurs in children in endemic areas.
    • Hepatitis C
    • Hydatid cyst
    • Leprosy
    • Malaria
    • Schistosomiasis
    • Syphilis
  • Malignancy: This is responsible for approximately 5-10% of cases of membranous nephropathy, with the higher risk occurring in patients older than 60 years.
    • Carcinoma (solid organ)
    • Leukemia
    • Lymphoma
    • Melanoma
  • Drugs
    • Captopril
    • Gold
    • Lithium
    • Mercury-containing compounds
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): They are an uncommon cause; they are usually associated with minimal-change disease.
    • Penicillamine
    • Probenecid
  • Miscellaneous
    • De novo in renal allografts: The onset is delayed compared to recurrent disease. The rate of graft loss may be as high as 50%. Recurrence is infrequent, with rates of 3-7%. This can lead to loss of the graft. Membranous nephropathy recurs in 5-10% of patients.
    • Diabetes (uncommon)
    • Kimura disease
    • Sarcoidosis
    • Sickle cell disease: This is uncommon. It usually produces focal segmental glomerulosclerosis.
    • Systemic mastocytosis
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Contributor Information and Disclosures
Author

Abeera Mansur, MD  Consultant Nephrologist, Doctors Hospital and Medical Center, Pakistan

Abeera Mansur, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

James H Sondheimer, MD, FACP  Associate Professor of Medicine, Wayne State University School of Medicine; Medical Director of Hemodialysis, Harper University Hospital at Detroit Medical Center; Medical Director, DaVita Greenview Dialysis (Southfield)

James H Sondheimer, MD, FACP is a member of the following medical societies: American College of Physicians and American Society of Nephrology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ajay K Singh, MB, MRCP, MBA  Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Renal Ventures Ownership interest Other

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

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