Membranous Glomerulonephritis Treatment & Management

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

Medical Care

Search for an underlying cause. Successful treatment of the underlying cause may be curative in secondary forms.

  • A low-salt diet is key to reducing anasarca. Protein restrictions may or may not be useful in reducing the rate of progression of chronic renal failure.
  • Diuretics help control edema. Loop diuretics are used most often.
  • NSAIDs help to decrease the proteinuria. These have been largely supplanted by angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).
  • ACE inhibitors decrease proteinuria and control hypertension; use ARBs for patients intolerant of ACE inhibitors.
  • Hepatic 3-methylglutaryl coenzyme A reductase inhibitors help treat hypercholesterolemia.
  • Routine anticoagulation is controversial. However, the risk of renal vein thrombosis and other deep vein thromboses is significant, and the clinician must be vigilant in monitoring for signs of venous thrombosis. Once found, anticoagulation is generally continued indefinitely. In a study of membranous nephropathy, the risk of developing VTE (venous thromboembolism) increased 3.9-fold with a reduction in serum albumin below the threshhold of 2.8g/dl and 5.8-fold with a serum albumin of less than 2.2 g/dl.[6]
  • In hepatitis-associated membranous nephropathy, antivirals may be useful.
  • Treat hypertension aggressively.
  • Do not treat patients with asymptomatic nonnephrotic proteinuria with immunosuppressives. Patients who are asymptomatic and nephrotic may undergo remission, particularly if they have normal renal function and an early lesion. They may also be observed.
  • Therapy with immunosuppressive agents is indicated in those patients who have the following:
    • Increased creatinine level at presentation
    • Progressive disease
    • Severe symptomatic nephrotic syndrome
    • Persistent nephrotic syndrome
    • Thromboembolism
    • Persistent nephrotic syndrome, male sex, and age older than 50 years
    • Increased IgG excretion, HLA-DR3+/B8+, white race, and elevation of urinary excretion of complement activation products
    • Tubulointerstitial changes or focal sclerosis
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Surgical Care

Transplantation is indicated if the patient progresses to ESRD. Some risk of recurrence in the allograft is recognized.

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Diet

  • Institute a low-salt diet.
  • Protein restrictions may or may not be useful.
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Activity

  • Activity can be performed as tolerated.
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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.

References

  1. Ronco P, Debiec H. New insights into the pathogenesis of membranous glomerulonephritis. Curr Opin Nephrol Hypertens. May 2006;15(3):258-63. [Medline].

  2. Beck LH Jr, Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. Jul 2 2009;361(1):11-21. [Medline]. [Full Text].

  3. Debiec H, Lefeu F, Kemper MJ, Niaudet P, Deschênes G, Remuzzi G, et al. Early-childhood membranous nephropathy due to cationic bovine serum albumin. N Engl J Med. Jun 2 2011;364(22):2101-10. [Medline].

  4. Chen A, Frank R, Vento S, et al. Idiopathic membranous nephropathy in pediatric patients: presentation, response to therapy, and long-term outcome. BMC Nephrol. Aug 6 2007;8:11. [Medline].

  5. El Kossi M, Harmer A, Goodwin J, et al. De novo membranous nephropathy associated with donor-specific alloantibody. Clin Transplant. Jan-Feb 2008;22(1):124-7. [Medline].

  6. Lionaki S, Derebail VK, Hogan SL, Barbour S, Lee T, Hladunewich M, et al. Venous thromboembolism in patients with membranous nephropathy. Clin J Am Soc Nephrol. Jan 2012;7(1):43-51. [Medline]. [Full Text].

  7. Polenakovic M, Grcevska L, Dzikova S. 20 years after methylprednisolone/chlorambucil treatment in idiopathic membranous nephropathy stage II-III with nephrotic syndrome. Prilozi. Dec 2006;27(2):5-12. [Medline].

  8. Branten AJ, du Buf-Vereijken PW, Vervloet M, et al. Mycophenolate mofetil in idiopathic membranous nephropathy: a clinical trial with comparison to a historic control group treated with cyclophosphamide. Am J Kidney Dis. Aug 2007;50(2):248-56. [Medline].

  9. Ruggenenti P, Cravedi P, Remuzzi G. Latest treatment strategies for membranous nephropathy. Expert Opin Pharmacother. Dec 2007;8(18):3159-71. [Medline].

  10. Cravedi P, Ruggenenti P, Sghirlanzoni MC, et al. Titrating rituximab to circulating B cells to optimize lymphocytolytic therapy in idiopathic membranous nephropathy. Clin J Am Soc Nephrol. Sep 2007;2(5):932-7. [Medline].

  11. Fervenza FC, Cosio FG, Erickson SB, et al. Rituximab treatment of idiopathic membranous nephropathy. Kidney Int. Jan 2008;73(1):117-25. [Medline].

  12. Chuang TW, Hung CH, Huang SC, et al. Complete remission of nephrotic syndrome of hepatitis B virus-associated membranous glomerulopathy after lamivudine monotherapy. J Formos Med Assoc. Oct 2007;106(10):869-73. [Medline].

  13. [Best Evidence] Troyanov S, Roasio L, Pandes M, et al. Renal pathology in idiopathic membranous nephropathy: a new perspective. Kidney Int. May 2006;69(9):1641-8. [Medline].

  14. Cameron JS. The nephrotic syndrome and its complications. Am J Kidney Dis. Sep 1987;10(3):157-71. [Medline].

  15. Choi MJ, Eustace JA, Gimenez LF, et al. Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int. Mar 2002;61(3):1098-114. [Medline].

  16. Coupes B, Brenchley PE, Short CD, et al. Clinical aspects of C3dg and C5b-9 in human membranous nephropathy. Nephrol Dial Transplant. 1992;7 Suppl 1:32-4. [Medline].

  17. Cunningham PN, Quigg RJ. Contrasting roles of complement activation and its regulation in membranous nephropathy. J Am Soc Nephrol. May 2005;16(5):1214-22. [Medline].

  18. Haas M, Meehan SM, Karrison TG, et al. Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997. Am J Kidney Dis. Nov 1997;30(5):621-31. [Medline].

  19. Hogan SL, Muller KE, Jennette JC, et al. A review of therapeutic studies of idiopathic membranous glomerulopathy. Am J Kidney Dis. Jun 1995;25(6):862-75. [Medline].

  20. Honkanen E, Tornroth T, Gronhagen-Riska C. Natural history, clinical course and morphological evolution of membranous nephropathy. Nephrol Dial Transplant. 1992;7 Suppl 1:35-41. [Medline].

  21. Hunt LP. Statistical aspects of survival in membranous nephropathy. Nephrol Dial Transplant. 1992;7 Suppl 1:53-9. [Medline].

  22. Kuroki A, Iyoda M, Shibata T, et al. Th2 cytokines increase and stimulate B cells to produce IgG4 in idiopathic membranous nephropathy. Kidney Int. Jul 2005;68(1):302-10. [Medline].

  23. Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int. Jan 1995;47(1):225-30. [Medline].

  24. Muirhead N. Management of idiopathic membranous nephropathy: evidence-based recommendations. Kidney Int Suppl. Jun 1999;70:S47-55. [Medline].

  25. Nangaku M, Shankland SJ, Couser WG. Cellular response to injury in membranous nephropathy. J Am Soc Nephrol. May 2005;16(5):1195-204. [Medline].

  26. Ponticelli C, Zucchelli P, Passerini P, et al. A 10-year follow-up of a randomized study with methylprednisolone and chlorambucil in membranous nephropathy. Kidney Int. Nov 1995;48(5):1600-4. [Medline].

  27. Reichert LJ, Koene RA, Wetzels JF. Prognostic factors in idiopathic membranous nephropathy. Am J Kidney Dis. Jan 1998;31(1):1-11. [Medline].

  28. Reichert LJ, Koene RA, Wetzels JF. Urinary excretion of beta 2-microglobulin predicts renal outcome in patients with idiopathic membranous nephropathy. J Am Soc Nephrol. Dec 1995;6(6):1666-9. [Medline].

  29. Ruggenenti P, Chiurchiu C, Brusegan V, et al. Rituximab in idiopathic membranous nephropathy: a one-year prospective study. J Am Soc Nephrol. Jul 2003;14(7):1851-7. [Medline].

  30. Schieppati A, Perna A, Zamora J, et al. Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome. Cochrane Database Syst Rev. Oct 18 2004;CD004293. [Medline].

  31. Yokoyama H, Yoshimoto K, Wada T. [Membranous nephropathy]. Nippon Rinsho. Oct 2004;62(10):1856-60. [Medline].

 
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