Membranous nephropathy is a diagnostic term in pathological morphology. Characteristic pathological changes in membranous nephropathy is deposition of immune lot in the epithelial side of glomerular capillary loop complex.
It is more common among people who are above 40 years. Most patients start with the symptoms of nephrotic syndrome and there are about 20% of patients have asymptomatic proteinuria.
No big difference in the natural disease course and may not be three types of forecasting spontaneous remission ---, persistent proteinuria with normal renal function, persistent proteinuria with progressive loss of renal function.
If patients have only asymptomatic proteinuria and renal functions are still normal, no specific treatment can be offered. For those who have massive proteinuria, first are required to immunosuppressive therapies can help reduce proteinuria, alleviating complications and slow rate of renal function deterioration.
Nonspecific therapies
They are suitable for young patients with normal renal function, normal or slightly reduced plasma albumin and proteinuria to less than 3.5g / d.
Controlling blood pressure: Blood pressure should be less than 125 / 70mmHg. Medications may include ACEI and ARB.
Anticoagulation: There is a high incidence of venous thrombosis in membranous nephropathy, therefore preventive anticoagulation is necessary especially if patients have long term hypoproteinemia.
Low protein diets: Those with massive proteinuria should limit daily intake of proteins within 0.8g / kg.
Other: Including edema and hyperlipidemia etc.
Immune Therapy
Immunosuppressive application depends on severity and duration of proteinuria and renal function. Generally speaking, immune therapy should be given in case of proteinuria more than 3.5g / d with decreased renal function.
Single use of hormones usually turns out to be ineffective and the combination of hormones and cytotoxic drugs may help some patients achieve clinical remission. Commonly prescribed medications include prednisone, cyclosporine A, Tripterygium glycosides, tacrolimus and Rituxan etc.
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