Membranous nephropathy: A review on the pathogenesis, diagnosis, and treatment

Abstract

In adults, membranous nephropathy (MN) is a major cause of nephrotic syndrome. However, the etiology of approximately 75% of MN cases is idiopathic. Secondary causes of MN are autoimmune diseases, infection, drugs, and malignancy. The pathogenesis of MN involves formation of immune complex in subepithelial sites, but the definite mechanism is still unknown. There are three hypotheses about the formation of immune complex, including preformed immune complex, in situ immune-complex formation, and autoantibody against podocyte membrane antigen. The formation of immune complex initiates complement activation, which subsequently leads to glomerular damage. Recently, the antiphospholipase A2 receptor antibody was found to be associated with idiopathic MN. This finding may be useful in the diagnosis and prognosis of MN. The current treatment includes best supportive care, which consists of the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, lipid-lowering agents, and optimal control of blood pressure. Immunosuppressive agents should be used for patients who suffer from refractory proteinuria or complications associated with nephrotic syndrome. Existing evidence supports the use of a combination of steroid and alkylating agents. This article reviews the epidemiology, pathogenesis, diagnosis, and the treatment of MN.

Renal involvement in primary Sjögren's syndrome: A retrospective study of 103 biopsy‐proven cases from a single center in China

“…The pathogenesis of MN involves the formation of immune complexes within subepithelial sites. 15 In previous studies, membranoproliferative glomerulonephritis (MPGN) secondary to cryoglobulinemia was the most common glomerulonephritic diagnosis in SS patients. 16,17 MPGN related to cryoglobulinemia was not observed in our study.…”

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

“…Leflunomide (LEF) is an inhibitor of dihydroorotate dehydrogenase (DHODH) and has been used to treat patients with rheumatoid arthritis, membranous nephropathy, psoriatic arthritis, and ankylosing spondylitis. 4 To do this, the efficacy of combined effect of prednisone and LEF was assessed, and prednisone combined with CTX was administered as the control. …”

The Prognostic Significance of IgG4 Deposition in Membranous Nephropathy and Its Impact on the Therapeutic Regimen

“…The presence of these antibodies were shown to be correlated to the clinical activity of MN [11]. Because of this, the severity of MN can be well monitored and subsequently, improve in the management of the disease [1,10].…”

“…Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults worldwide, and 75% of cases are idiopathic [1]. It is an autoimmune disease characterized by thickening of the glomerular capillary basement membrane due to inflammation [1][2].…”

“…It is an autoimmune disease characterized by thickening of the glomerular capillary basement membrane due to inflammation [1][2]. At the molecular level, an autoimmune attack against podocytes occurs.…”