Skip to main content

Membranous Nephropathy

  • Chapter
  • First Online:
Practical Nephrology

Abstract

Membranous nephropathy (MN) is the most common cause of primary nephrotic syndrome in adults: recent figures from the Netherlands show an incidence of around ten per million population per year [1]. Identical clinical presentation and histological appearances can occur whether the condition is primary or ‘idiopathic’ (IMN) or when it is secondary to various drugs, infections or tumours (see Table 17.1), so that careful consideration to exclude an underlying cause is needed when assessing each new patient. When such a cause can be identified, the prognosis is that of the underlying condition and management should be directed towards that condition: causative drugs should be stopped and infections or tumours treated and eradicated if possible. If successful the secondary MN can be expected to resolve.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hofstra JM, Wetzels JFM. Introduction of a cyclophosphamide-based strategy and the risk of ESRD in patients with idiopathic membranous nephropathy: a nationwide survey in the Netherlands. Nephrol Dial Transplant. 2008;23:3534–8.

    Article  CAS  PubMed  Google Scholar 

  2. Ponticelli C. Membranous nephropathy. J Nephrol. 2007;20(3):268–87.

    Google Scholar 

  3. Lien YH, Lai LW. Pathogenesis, diagnosis and management of paraneoplastic glomerulonephritis. Nat Rev Nephrol. 2011;7(2):85–95.

    Google Scholar 

  4. Beck LH Jr. Membranous nephropathy and malignancy. Semin Nephrol. 2010;30(6):635–44.

    Google Scholar 

  5. Mathieson PW. Membranous nephropathy. Br J Ren Med. 2002;7:17–20.

    Google Scholar 

  6. Glassock RJ. The pathogenesis of idiopathic membranous nephropathy: a 50-year odyssey. Am J Kidney Dis. 2010;56:157–67.

    Article  PubMed  Google Scholar 

  7. Cybulsky AV. Membranous nephropathy. Contrib Nephrol. 2011;169:107–25.

    Article  CAS  PubMed  Google Scholar 

  8. Debiec H, Nauta J, Coulet F, et al. Role of truncating mutations in MME gene in fetomaternal alloimmunisation and antenatal glomerulopathies. Lancet. 2004;364:1252–9.

    Article  CAS  PubMed  Google Scholar 

  9. Beck Jr LH, Bonegio RG, Lambeau G, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361:11–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Debiec H, Ronco P. PLA2R autoantibodies and PLA2R glomerular deposits in membranous nephropathy. N Engl J Med. 2011;364:689–90.

    Article  CAS  PubMed  Google Scholar 

  11. Qin W, Beck Jr LH, Zeng C, et al. Anti-phospholipase A2 receptor antibody in membranous nephropathy. J Am Soc Nephrol. 2011;22:1137–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Cravedi P, Ruggenenti P, Remuzzi G. Circulating anti-PLA2R autoantibodies to monitor immunological activity in membranous nephropathy. J Am Soc Nephrol. 2011;22:1400–2.

    Article  CAS  PubMed  Google Scholar 

  13. Beck Jr LH, Salant DJ. Membranous nephropathy: recent travels and new roads ahead. Kidney Int. 2010;77:765–70.

    Article  CAS  PubMed  Google Scholar 

  14. Stanescu HC, Arcos-Burgos M, Medlar A, et al. Risk HLA-DQA1 and PLA(2)R1 alleles in idiopathic membranous nephropathy. N Engl J Med. 2011;364:616–26.

    Article  CAS  PubMed  Google Scholar 

  15. Makker SP, Tramontano A. Idiopathic membranous nephropathy: an autoimmune disease. Semin Nephrol. 2011;31:333–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Nickolas TL, Radhakrishnan J, Appel GB. Hyperlipidemia and thrombotic complications in patients with membranous nephropathy. Semin Nephrol. 2003;23(4):406–11.

    Google Scholar 

  17. Barbour SJ, Greenwald A. Djurdjev O, et al. Disease-specific risk of venous thromboembolic events is increased in idiopathic glomerulonephritis. Kidney Int. 2012;81(2):190–5.

    Google Scholar 

  18. Polanco N, Gutierrez E. Covarsi A, et al. Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. J Am Soc Nephrol. 2010;21(4):697–704.

    Google Scholar 

  19. KDIGO clinical practice guidelines for glomerulonephritis. Kidney Int Suppl. 2012;2(2):187–97.

    Google Scholar 

  20. Glassock RJ. Prophylactic anticoagulation in nephrotic syndrome: a clinical conundrum. J Am Soc Nephrol. 2007;18(8):2221–5.

    Google Scholar 

  21. Schieppati A, Perna A, Zamora J, et al. Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome. Cochrane Database Syst Rev. 2004;(4):CD004293.

    Google Scholar 

  22. 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. 1995;48:1600–4.

    Article  CAS  PubMed  Google Scholar 

  23. Ponticelli C, Altieri P, Scolari F, et al. A randomized study comparing methylprednisolone plus chlorambucil versus methylprednisolone plus cyclophosphamide in idiopathic membranous nephropathy. J Am Soc Nephrol. 1998;9:444–50.

    CAS  PubMed  Google Scholar 

  24. Howman A, et al. The UK randomised controlled trial of immunosuppression for progressive membranous nephropathy. Lancet. 2013;381(9868):744–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Beck Jr LH, Fervenza FC, Beck DM, et al. Rituximab-induced depletion of anti-PLA2R autoantibodies predicts response in membranous nephropathy. J Am Soc Nephrol. 2011;22:1543–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Ponticelli C, Passerini P, Salvadori M, et al. A randomized pilot trial comparing methylprednisolone plus a cytotoxic agent versus synthetic adrenocorticotropic hormone in idiopathic membranous nephropathy. Am J Kidney Dis. 2006;47:233–40.

    Article  CAS  PubMed  Google Scholar 

  27. Molloy ES, Calabrese LH. Progressive multifocal leukoencephalopathy associated with immunosuppressive therapy in rheumatic diseases: evolving role of biologic therapies. Arthritis Rheum. 2012;64:3043–51.

    Article  CAS  PubMed  Google Scholar 

  28. Lindskog A, Ebefors K, Johansson ME, et al. Melanocortin 1 receptor agonists reduce proteinuria. J Am Soc Nephrol. 2010;21:1290–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Ivanyi B. A primer on recurrent and de novo glomerulonephritis in renal allografts. Nat Clin Pract Nephrol. 2008;4(8):446–57.

    Google Scholar 

  30. Sprangers B, Lefkowitz GI, Cohen SD, et al. Beneficial effect of rituximab in the treatment of recurrent idiopathic membranous nephropathy after kidney transplantation. Clin J Am Soc Nephrol. 2010;5(5):790–7.

    Google Scholar 

  31. Reichert LJ, Koene RA, Wetzels JF. Prognostic factors in idiopathic membranous nephropathy. Am J Kidney Dis. 1998;31(1):1–11.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter W. Mathieson PhD, FRCP, FMedSci .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Mathieson, P.W. (2014). Membranous Nephropathy. In: Harber, M. (eds) Practical Nephrology. Springer, London. https://doi.org/10.1007/978-1-4471-5547-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5547-8_17

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5546-1

  • Online ISBN: 978-1-4471-5547-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics