eMedicine Specialties > Nephrology > Glomerular Diseases

Glomerulonephritis, Membranous: Follow-up

Author: Abeera Mansur, MD, Consultant Nephrologist, Doctors Hospital and Medical Center, Pakistan
Contributor Information and Disclosures

Updated: Dec 16, 2008

Follow-up

Further Outpatient Care

  • Management is on an outpatient basis, with emphasis on controlling blood pressure. Observation for signs and symptoms of renal vein thrombosis, deep vein thrombosis, and pulmonary embolism is crucial in these patients.
  • Renal function, proteinuria (measured by the ratio of urinary protein to creatinine), and electrolytes need to be monitored at regular intervals.
  • Additional monitoring is indicated for pharmacologic interventions.

Complications

  • Most complications are associated with heavy proteinuria.
  • Serositis is a possible complication.
  • Hypovolemia, with the possibility of acute renal failure, may occur in patients who are overdiuresed. Hypovolemia exacerbates the adverse renal effects of ACE inhibitors, ARBs, and NSAIDs.
  • Increased incidence of infection may be present, even in patients not receiving immunosuppressives.
  • Hyperfibrinogenemia and erythrocytosis may lead to a hypercoagulable state, particularly renal vein thrombosis. Nephrotic syndrome may also result in loss of antithrombin III.
  • Lethargy and tiredness are complications.
  • An increased incidence of ischemic heart disease has not been proven.

Prognosis

  • The outcome depends on the renal function at the time of diagnosis and the amount of proteinuria, ranging from remission without medication to ESRD.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Factors predicting a more aggressive disease should be taken into account before starting immunosuppressive therapy. Failure to diagnose renal vein thrombosis may result in potentially lethal pulmonary embolism; on the other hand, use of anticoagulation is fraught with risks, particularly in patients with nephrotic syndrome and renal insufficiency.

Special Concerns

  • The threshold to rule out thromboembolic phenomenon should be low.
 


More on Glomerulonephritis, Membranous

Overview: Glomerulonephritis, Membranous
Differential Diagnoses & Workup: Glomerulonephritis, Membranous
Treatment & Medication: Glomerulonephritis, Membranous
Follow-up: Glomerulonephritis, Membranous
References
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References

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Further Reading

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Keywords

membranous glomerulonephritis, membranous nephropathy, nephrotic syndrome

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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.

Medical Editor

James H Sondheimer, MD, Director of Hemodialysis Unit, Harper Hospital; Associate Professor, Department of Internal Medicine, Division of Nephrology, Wayne State University School of Medicine
James H Sondheimer, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ajay K Singh, MB, MRCP, MBA, Associate Professor of Medicine, Director of Dialysis, Department of Medicine, Harvard Medical School; Clinical Chief of Renal Division, Brigham and Women's Hospital
Disclosure: Nothing to disclose.

CME Editor

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 Osteopathic Internists, 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: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Roche Honoraria Consulting

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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