Membranous glomerulonephritis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
Membranous glomerulonephritis was first discovered by David Jones, renal pathologist from Syracuse University in New York, in 1957.
Classification
There is no established system for the classification of MGN. however it can be divided in two groups based on etiology of MGN.
Pathophysiology
Membranous glomerulonephritis is caused by immune complex formation in the glomerulus. The immune complexes are formed by binding of antibodies to antigens in the glomerular basement membrane. The antigens may be part of the basement membrane, or deposited from elsewhere by the systemic circulation. The immune complex serves as an activator that triggers a response from the complement system and form a membrane attack complex which stimulates release of proteases and oxidants by the mesangial and epithelial cells, damaging the capillary walls and causing them to become leaky. It is thought that MGN is mediated by genetic factors like PLA2R, enviromental factors, drug (captopril) side effects, infections like hepatitis B and hepatitis C
Causes
The main causes of Membranous Glomerulonephritis are Infectious causes like Hepatitis B, drugs like captopril and autoimmune diseases like systemic lupus erythematosus.
Differentiating Hereditary pancreatitis from Other Diseases
MGN must be differentiated from other diseases that cause proteinuria, weight loss, and renal failure, such as MPGN, MCD, and FSGC.
Epidemiology and Demographics
The Incidence rate of Membranous Glomerulonephritis is 27 per 100.000. The prevalence rate of Membranous Glomerulonephritis is 690 per 100,000
Risk Factors
The most potent risk factor in the development of [disease name] is drugs. Other risk factors include penicilliamine and captopril.
Screening
There is insufficient evidence to recommend routine screening for membranous glomerulonephritis.
Natural History, Complications, and Prognosis
Common complications of membranous glomerulonephritis include renal failure.
Diagnosis
Diagnostic Criteria
The most efficient and sensitive test is ANA, ds-DNA antibodies specific test that is utilized for diagnosis of membranous glomerulonephritis. The gold standard test for the diagnosis of biopsy.
History and Symptoms
The hallmark of membranous glomerulonephritis is nephrotic syndrome. A positive history of forthy urine and headache are suggestive of membranous glomerulonephritis.
Physical Examination
Common physical examination findings of membranous glomerulonephritis include edematous feets and headache.
Laboratory Findings
The major laboratory workup includes blood workup, auto-immune workup and urine workup.
Electrocardiogram
There are no ECG findings associated with membranous glomerulonephritis.
X-ray
There are no x-ray findings associated with membranous glomerulonephritis.
Ultrasound
There are no echocardiography and ultrasound findings associated with membranous glomerulonephritis.
CT scan
There are no CT scan findings associated with membranous glomerulonephritis.
MRI
There are no MRI findings associated with membranous glomerulonephritis.
Other Imaging Findings
There are no other imaging findings associated with membranous glomerulonephritis
Other Diagnostic Studies
The patients with compromised renal functions are indicated for biopsy
Treatment
Medical Therapy
lipid lowering and Anticoagulation for better blood flow. Diuretics to reduce edema. Angiotensin inhibition ACE inhibitor or an angiotensin II receptor blocker (ARB) are recomended to reduce renal vascular damage.
Surgery
Surgery is not the first-line treatment option for patients with MGN. Surgery is usually reserved for patients requiring renal transplant.
Primary Prevention
There are no established measures for the primary prevention of MGN.
Secondary Prevention
There are no established measures for the secondary prevention of MGN.