A common cause of the nephrotic syndrome in adults. The diagnosis is established by renal biopsy, which shows diffuse global subepithelial deposits within the glomerulus. Most cases of membranous nephropathy are idiopathic, but there are associations with infection (e.g. hepatitis B), malignancy (especially lung cancer), autoimmune disease (e.g. SLE, Hashimoto’s disease), and drugs (e.g. gold and penicillamine). Recent studies suggest that idiopathic membranous nephropathy is an autoimmune disease with antibodies directed against an antigen (PLA2R, a phospholipase A2 receptor) on the podocyte cell membrane. Without treatment, outcome is very variable: some patients will make a full recovery, while others will progress to end-stage kidney failure. Immunosuppressant treatment is often tried when there is evidence of declining renal function.
Subjects: Medicine and Health.