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Membranous Nephropathy

Primary Nephrotic Syndrome in Adults

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

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What is Membranous Nephropathy?

Membranous nephropathy features diffusely thickened glomerular basement membranes with subepithelial immune complex deposits and spike/dome patterns on electron microscopy.

Primary disease is driven by autoantibodies, most commonly against PLA2R (70-80%), thrombospondin type-1 domain-containing 7A (THSD7A), or other podocyte antigens.

Secondary causes include hepatitis B, autoimmune disease (SLE), malignancy, and medications (NSAIDs, gold, penicillamine).

Natural history follows rule of thirds — remission, persistent proteinuria, or progression to CKD; anti-PLA2R titer correlates with activity.

Symptoms

Nephrotic-range proteinuria and foamy urine
Peripheral edema, ascites, and weight gain
Hypoalbuminemia and hyperlipidemia
Thromboembolic events (deep vein, renal vein thrombosis, PE)
Relatively preserved GFR early in course
Hypertension in subset of patients

Risk Factors

Age 40-60 years, male predominance
Autoimmune disease (SLE most common secondary cause)
Hepatitis B or C infection
Malignancy (solid tumors in older patients)
Exposure to NSAIDs, gold, penicillamine, or certain captopril-like agents
Anti-PLA2R or anti-THSD7A antibodies

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New onset nephrotic-range proteinuria in an adult
  • Signs of thromboembolism (leg swelling, chest pain, acute pulmonary symptoms)
  • Rising creatinine or persistent high proteinuria after 6 months of supportive care

Treatment Methods

01
Supportive therapy: ACEi or ARB, statin, salt restriction, loop diuretics for edema
02
Anticoagulation prophylaxis when albumin <2.5 g/dL or other thrombotic risk
03
Identify and treat secondary cause (antivirals for hepatitis, stop offending drugs, malignancy workup)
04
Immunosuppression for primary MN with persistent nephrotic syndrome or declining GFR
05
First-line regimens: rituximab, cyclophosphamide + corticosteroids (Ponticelli), or calcineurin inhibitors + steroids
06
Monitor anti-PLA2R titers as biomarker of response; nephrology follow-up for relapse surveillance

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.