Pathogenesis and Treatment of Membranous Nephropathy

  • J. Stewart Cameron
Conference paper


A 19-year-old woman was admitted to New England Medical Center Hospital (NEMCH) for evaluation of the nephrotic syndrome. The patient was in excellent health until proteinuria was first detected 10 months earlier during the third month of her first pregnancy. Twenty-four-hour urine protein excretion remained in the 5–10-g range, and progressive pedal, hand, and periorbital edema developed. During the final weeks of the pregnancy, hypertension was present (systolic blood pressure, 140–150 mmHg; diastolic blood pressure, 90–96 mmHg). A healthy infant girl was delivered approximately 3 months prior to admission. Following delivery, the edema persisted. The patient’s serum albumin concentration varied between 3.1 and 2.0 g/100 m1, serum creatinine concentration remained normal, and 24-h urine protein excretion varied between 4 and 15 g.


Nephrotic Syndrome Immune Complex Membranous Nephropathy Serum Creatinine Concentration Idiopathic Membranous Nephropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gärtner HV, Fischbach H, Wehner H, Bohle A, Edel HH, Kluthe R, Scheler F, Schmulling RM: Comparison of clinical and morphological features of peri-(epi-, extra-) membranous glomerulonephritis. Nephron 13: 288–301, 1974PubMedCrossRefGoogle Scholar
  2. 2.
    Sinniah R, Feng PH: Lupus nephritis: Correlation between light, electron microscopic and immunofluorescent findings and renal function. Clin Nephrol 6: 340–351, 1976PubMedGoogle Scholar
  3. 3.
    Combes B, Stastny P, Shorey J, Elgenbrodt EH, Barrera A, Hull AR, Carter NW: Glomerulonephritis with deposition of Australia antigen-antibody complexes in glomerular basement membrane. Lancet 2: 234–237, 1971PubMedCrossRefGoogle Scholar
  4. 4.
    Pickering RJ, Michael AF, Herdman RC, Good RA, Gewurz H: The complement system in chronic glomerulonephritis—three newly associated aberrations. J Pediatr 78: 30–43, 1971PubMedCrossRefGoogle Scholar
  5. 5.
    Libit SA, Burke B, Michael AF, Vernier RL: Extramembranous glomerulonephritis in childhood: Relationship to systemic lupus erythematosus. J Pediatr 88: 394–402, 1976PubMedCrossRefGoogle Scholar
  6. 6.
    Simenhoff ML, Merrill JP: The spectrum of lupus nephritis. Nephron 1: 348–375, 1964PubMedCrossRefGoogle Scholar
  7. 7.
    Burkholder PM, Hyman LR, Krueger RP: Characterization of mixed membranous and proliferative glomerulonephritis. Recognition of three varieties. In Kincaid-Smith P, Mathew TH, Becker EL (eds.): Glomerulonephritis I. New York, Wiley, 1973, pp. 557–559Google Scholar
  8. 8.
    World MJ: Variables discriminating between cryptogenic glomerular lesions in adults with the nephrotic syndrome. Q J Med 45: 451–468, 1976PubMedGoogle Scholar
  9. 9.
    International Study of Kidney Disease in Children. Nephrotic syndrome in childhood: Prediction of histopathology from clinical and laboratory charactersitics at time of diagnosis. Kidney Int 13: 159–165, 1978CrossRefGoogle Scholar
  10. 10.
    Coggins CH: Study of adult idiopathic nephrotic syndrome. Abstr Int Congr Nephrol, Montreal, 1978, p. D36Google Scholar
  11. 11.
    Studd JWW, Blainey JD: Pregnancy and the nephrotic syndrome. Br Med J 1: 276–280, 1960CrossRefGoogle Scholar
  12. 12.
    Strauch BS, Hayslett JP: Kidney disease and pregnancy. Br Med J 4: 578–582, 1974PubMedCrossRefGoogle Scholar
  13. 13.
    Editorial: Pregnancy after treatment for renal failure. Lancet 1: 861, 1978Google Scholar
  14. 14.
    Wass JAH, Watkins PJ, Dische FE, Parsons V: Atypical glomerular disease in diabetes mellitus. Proc EDTA 13: 546–552, 1976Google Scholar
  15. 15.
    Churg J, Ehrenreich T: Membranous nephropathy. In Kincaid-Smith P, Mathew TH, Becker EL (eds.): Glomerulonephritis I. New York, Wiley, 1973, pp. 443–448Google Scholar
  16. 16.
    Ehrenreich T, Churg J: Pathology of membranous nephropathy. Path Ann 3: 145–168, 1968Google Scholar
  17. 17.
    Ooi YM, Ooi BS, Pollak VE: Relationship of levels of circulating immune complexes to histologic patterns of nephritis: A comparative study of membranous glomerulopathy and diffuse proliferative glomerulonephritis. J Lab Clin Med 90: 891–898, 1977PubMedGoogle Scholar
  18. 18.
    Stuhlinger WD, Verroust PJ, Morel-Maroger L: Detection of circulating immune complexes in patients with various renal diseases. Immunology 30: 43–47, 1976PubMedGoogle Scholar
  19. 19.
    Woodroffe AJ, Border WA, Theofilopoulos AN, Gore O, Glassock RJ, Dixon FJ, Wilson CB: Detection of circulating immune complexes in patients with glomerulonephritis. Kidney Int 12: 268–278, 1977PubMedCrossRefGoogle Scholar
  20. 20.
    Border W, Abrass C, Hall C, Brown C, Glassock R, Coggins C: Detection of circulating immune complexes (iCK) in adult idiopathic nephrotic syndrome (AINS). Kidney Int 13: 58A, 1978Google Scholar
  21. 21.
    Germuth FG, Rodriguez E: The immunopathology of the renal glomerulus. Boston, Little, Brown, 1973Google Scholar
  22. 22.
    Germuth FG, Taylor TJ, Siddiqui SY, Rodriguez E: Immune complex disease. VI: Some determinants of the varieties of glomerular lesions in the chronic bovine serum albumin-rabbit system. Lab Invest 37: 162–169, 1977PubMedGoogle Scholar
  23. 23.
    Kuriyama T: Chronic glomerulonephritis induced by prolonged immunization in the rabbit. Lab Invest 28: 224–235, 1973PubMedGoogle Scholar
  24. 24.
    Koyama A, Niwa Y, Shigematsu H, Taniguchi M, Tada T: Studies on passive serum sickness. II. Factors determining the localization of antigenantibody complexes in the murine renal glomerulus. Lab Invest 38: 253–262, 1978PubMedGoogle Scholar
  25. 25.
    Mauer SM, Sutherland DER, Howard RJ, Fish AJ, Najarian JS, Michael AF: The glomerular mesangium. III. Acute immune mesangial injury. A new model of glomerulonephritis. J Exp Med 137: 553–570, 1973PubMedCrossRefGoogle Scholar
  26. 26.
    Golbus S, Wilson CB: Glomerulonephritis (GN) produced by the in situ formation of immune complexes on the glomerular basement membrane. Kidney Int 13: 61A, 1978Google Scholar
  27. 27.
    Evans DJ: Pathogenesis of membranous nephropathy. Lancet 1: 1143–1144, 1974PubMedCrossRefGoogle Scholar
  28. 28.
    Brenner BM, Bohrer MP, Baylis L, Deen WM: Determinants of glomerular permselectivity: Insights derived from observations in vivo. Kidney Int 12: 229–237, 1978CrossRefGoogle Scholar
  29. 29.
    Glassock RJ, Edgington TS, Watson JI, Dixon FE: Autologous immune complex nephritis induced with renal tubular antigen. II. The pathogenic mechanism. J Exp Med 127: 573–587, 1968PubMedCrossRefGoogle Scholar
  30. 30.
    Barabas AZ, Nagi AH, Lannigan R: Induction of autologous immune complex nephritis in rats by heterologous antikidney mitichondrial serum. Int Urol Nephrol 2: 303–308, 1970CrossRefGoogle Scholar
  31. 31.
    Feenstra K, Van Der Lee R, Greben HA, Arenos A, Hoedemaeker PJ: Experimental glomerulonephritis in the rat induced by antibodies directed against tubular antigens. I. The natural history of a histologic and immunohistologic study of light microscopic and ultrastructural level. Lab Invest 32: 235–242, 1975PubMedGoogle Scholar
  32. 32.
    Van Es CA, Blok APR, Schoenfeld L, Glassock RJ: Chronic nephritis induced by antibodies reacting with glomerular bound immune complexes. Kidney Int 11: 106–115, 1977PubMedCrossRefGoogle Scholar
  33. 33.
    Fleuren GJ, Lee RVD, Greben HA, Van Damme BJC, Hoedemaeker PHJ: Experimental glomerulonephritis in the rat induced by antibodies directed against tubular antigens. IV. Investigations into the pathogenesis of the model. Lab Invest 38: 496–501, 1978PubMedGoogle Scholar
  34. 34.
    Van Damme BJC, Fleuren GJ, Bakker WW, Vernier RL, Hoedemaeker PHJ: Experimental glomerulonephritis in the rat induced by antibodies directed against tubular antigens. Lab Invest 38: 502–509, 1978PubMedGoogle Scholar
  35. 35.
    Steinmuller DR, Belok S, Salant DJ, Stilmant MM, Lowenstein LM, Couser WG: Subepithelial (SE) immune complex (IC) deposits in experimental membranous nephropathy (MN) are formed in situ. Abstr Int Congr Nephrol, Montreal, 1978, p. G10Google Scholar
  36. 36.
    Cameron JS, Turner DR: Recurrent glomerulonephritis in allografted kidneys. Clin Nephrol 7: 47–54, 1977PubMedGoogle Scholar
  37. 37.
    Izui S, Lambert P-H, Miescher PA: In vitro demonstration of a particular affinity of glomerular basement membrane and collagen for DNA. A possible basis for local formation of DNA-anti-DNA complexes in systemic lupus erythematosus. J Exp Med 144: 428–443, 1976PubMedCrossRefGoogle Scholar
  38. 38.
    Izui S, Lambert P-H, Miescher PA: Failure to detect circulating DNA-anti-DNA complexes by four radioimmunological methods in patients with systemic lupus erythematosus. Clin Exp Immunol 30: 384–392, 1978Google Scholar
  39. 39.
    Davis JS, Godfrey SM, Winfield JB: Direct evidence for circulating DNA/anti-DNA complexes in systemic lupus erythematosus. Arthr Rheum 21: 17–22, 1978CrossRefGoogle Scholar
  40. 40.
    Naruse T, Kitamura K, Miyakawa Y, Shibata S: Deposition of renal tubular epithelial antigen along the glomerular capillary walls of patients with membranous glomerulonephritis. J Immunol 110: 1163–1166, 1973Google Scholar
  41. 41.
    Naruse T, Miyakawa Y, Kitamura K: Membranous glomerulonephritis mediated by renal tubular epithelial antigen-antibody complex. J Allerg Clin Immunol 54: 313–318, 1974CrossRefGoogle Scholar
  42. 42.
    Whitworth JA, Leibowitz S, Kennedy MC, Cameron JS, Evans DJ, Glassock RJ, Schoenfeld LS: Absence of glomerular renal tubular epithelial antigen in membranous glomerulonephritis. Clin Nephrol 5: 159–162, 1976PubMedGoogle Scholar
  43. 43.
    Ozawa T, Boedecker EA, Schorr W, Guggenheim S, McIntosh RM: Immune-complex disease with unilateral renal vein thrombosis. Arch Pathol Lab Med 100: 279–282, 1976PubMedGoogle Scholar
  44. 44.
    Costanza ME, Pinn V, Schwartz RS, Nathanson L: Carcinoembryonic antigen-antibody complexes in a patient with colonic carcinoma and nephrotic syndrome. N Engl J Med 289: 520–522, 1973PubMedCrossRefGoogle Scholar
  45. 45.
    Whitworth JA, Unger A, Cameron JS: Carcinoembryonic antigen in tumour-associated membranous nephropathy. Lancet 2: 611, 1975PubMedCrossRefGoogle Scholar
  46. 46.
    Bariéty J, Druet PH, LaGrue G, Samarq P: Milliez P: Les glomerulopathies “extramembraneuses” (GEM). Etude morphologique en microscopie optique electronique et en immunofluorescence. Path Biol (Paris) 18: 5–32, 1970Google Scholar
  47. 47.
    Gärtner HV, Watanabe T, Ott V, Adam A, Bohle A, Edel HH, Kluthe R, Renner E, Scheler F, Schmulling RM, Sieberth HG: Correlations between morphologic and clinical features in idiopathic perimembranous glomerulonephritis. A study on 403 renal biopsies of 367 patients. Curr T Pathol 65: 1–29, 1977Google Scholar
  48. 48.
    Row PG, Cameron JS, Turner DR, Evans DJ, White RHR, Ogg CS, Chantler C, Brown CB: Membranous nephropathy. Long-term follow-up and association with neoplasia. QJ Med 44: 207–239, 1975Google Scholar
  49. 49.
    Hopper J, Trew PA, Biava CG: Membranous nephropathy (MN) relative benignity in woman. Abst Int Congr Nephrol, Montreal, 1978, p. D2Google Scholar
  50. 50.
    Ehrenreich T, Porush JG, Churg J, Garfinkel L, Glabman S, Goldstein MH, Grishman E, Yunis SL: Treatment of idiopathic membranous nephropathy. N Engl J Med 295: 741–746, 1976PubMedCrossRefGoogle Scholar
  51. 51.
    Kleinknecht C, Broyer M, Habib R: Steroids for idiopathic membranous nephritis. N Engl J Med 296: 49, 1977CrossRefGoogle Scholar
  52. 52.
    Pierides AM, Malasit P, Morley AR, Wilkinson R, Uldall PR, Seere DNS: Idiopathic membranous nephropathy. QJ Med 46: 163–177, 1977Google Scholar
  53. 53.
    Cameron JS: The treatment of immunological renal disease. In Zabriskie J, Villareal H, Becker EL (eds.): Immunological Renal Disease.Google Scholar
  54. 54.
    Toulmin S: Human Understanding. Oxford, Clarendon Press, 1972, p. viGoogle Scholar
  55. 55.
    Idelson BA, Smithline N, Smith GW, Harrington JT: Prognosis in steroidtreated idiopathic nephrotic syndrome in adults. Arch Intern Med 137: 891–896, 1977PubMedCrossRefGoogle Scholar
  56. 56.
    Pollak VE, Pirani CL, Muehrcke RC, Kark RM: Asymptomatic persistent proteinuria: Studies by renal biopsies. Guy’s Hosp Rep 107: 353, 1958PubMedGoogle Scholar
  57. 57.
    Franklin WA, Jennings RB, Earle DP: Membranous glomerulonephritis: Long-term serial observations on clinical course and morphology. Kidney Int 4: 36–56, 1973PubMedCrossRefGoogle Scholar
  58. 58.
    Couser WG, Jermanovich NB, Belok S, Stilmant MM, Hoyer JR: Effect of aminonucleoside nephrosis on immune complex localization in autologous immune complex nephropathy in rats. J Clin Invest 61: 561–572, 1978PubMedCrossRefGoogle Scholar
  59. 59.
    Olsen S, Bohman SO, Petersen VP: Ultrastructure of the glomerular basement membrane in long-term renal allografts with transplant glomerular disease. Lab Invest 30: 176–189, 1977Google Scholar
  60. 60.
    Steinmuller DR, Stilmant MM, Idelson BA, Monaco AP, Sahyoun AI, Lewis EJ, Davis RC, Couser WG: De novo development of membranous nephropathy in cadaver renal allografts. Clin Nephrol 9: 210–218, 1978PubMedGoogle Scholar
  61. 61.
    Crosson JT, Wathen L, Raij L, Andersen C, Anderson R: Recurrence of idiopathic membranous nephropathy in a renal allograft. Arch Intern Med 135: 1101–1106, 1978CrossRefGoogle Scholar
  62. 62.
    Rubin RJ, Pinn VW, Barnes BA, Harrington JT: Recurrent idiopathic membranous glomerulonephritis. Transplantation 24: 4–9, 1977PubMedCrossRefGoogle Scholar
  63. 63.
    Bacon PA, Tribe CR, Mackenzie JC, Verrier Jones J, Cumming RH, Amer B: Penicillamine nephropathy in rheumatoid arthritis. A clinical, pathological and immunological study. QJ Med 45: 661–684, 1976Google Scholar
  64. 64.
    Gärtner HV, Neild GH, Bohle A, Hallauer W, Hoppe-Seyler G, Lüttgen FM, Schollmeyer P: Peripmernbranöse glomerulonephritis nach penicillamin-therapie. Bericht uber 31 fälle. Klin Wochenschr 53: 835–837, 1975PubMedCrossRefGoogle Scholar
  65. 65.
    Collaborative Study of the Adult Idiopathic Nephrotic Syndrome: A controlledstudy of short-term prednisone treatment in adults with membranous nephropathy. N Engl J Med 301: 1306, 1979Google Scholar

Copyright information

© International Society of Nephrology 1983

Authors and Affiliations

  • J. Stewart Cameron

There are no affiliations available

Personalised recommendations