Membranous glomerulonephritis

Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF). It usually presents with nephrotic syndrome or proteinuria.

Renal biopsy demonstrates:

• electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance

Causes

• idiopathic
• infections: hepatitis B, malaria, syphilis
• malignancy: lung cancer, lymphoma, leukaemia
• drugs: gold, penicillamine, NSAIDs
• autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

Prognosis - rule of thirds

• one-third: spontaneous remission
• one-third: remain proteinuric
• one-third: develop ESRF

Good prognostic features include female sex, young age at presentation and asymptomatic proteinuria of a modest degree at the time of presentation.

Management

• immunosuppression: corticosteroids alone have not been shown to be effective. A combination of corticosteroid + another agent such as chlorambucil is often used
• blood pressure control: ACE inhibitors have been shown to reduce proteinuria
• consider anticoagulation

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