Membranous Glomerulonephritis Clinical Presentation

Updated: Oct 09, 2019
  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

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  • 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

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  • 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. [12]

  • 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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