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Treatment of idiopathic membranous nephropathy

Author
Daniel C Cattran, MD
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Membranous nephropathy (MN) is among the most common causes of the nephrotic syndrome in nondiabetic adults, accounting for up to one-third of biopsy diagnoses. (See "Overview of heavy proteinuria and the nephrotic syndrome", section on 'Etiology'.)

MN in adults is most often idiopathic (approximately 75 percent of cases) but can be caused by a variety of drugs, infections, and underlying diseases. These include gold, penicillamine, systemic lupus erythematosus, malignancy, and hepatitis B and C virus infection (table 1).

It is often not possible to distinguish idiopathic from secondary MN on clinical grounds alone, even though serologic studies (eg, antinuclear antibodies, hepatitis B serology) and a history of drug exposure or cancer may be revealing of a potential cause. However, there are certain findings on electron microscopy and immunofluorescence that suggest secondary disease. In patients with secondary MN, cessation of the offending drug or effective treatment of the underlying disease is usually associated with improvement in the nephrotic syndrome. (See "Causes and diagnosis of membranous nephropathy".)

The treatment of idiopathic MN, beginning with a review of the natural history and risk factors for progressive disease, will be presented here. The clinical trials supporting the efficacy of initial immunosuppressive regimens and the effectiveness of alternative agents in unresponsive patients are discussed in detail separately. (See "Alternative agents in the treatment of idiopathic membranous nephropathy".)

NATURAL HISTORY

In view of the potential toxicity of the drugs used to treat idiopathic membranous nephropathy (MN), with or without the nephrotic syndrome, the decision to initiate therapy is based, in part, upon an understanding of the natural history of untreated patients, with and without features of the nephrotic syndrome at presentation [1-4]:

                                         

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 09 00:00:00 GMT 2016.
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