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Membranous Glomerulonephritis Treatment & Management

  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jan 22, 2014
 

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

See the list below:

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

See the list below:

  • 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, American Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, 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, International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Receive dialysis unit medical director fee (as independ ent contractor) for: DaVita .

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