MEMBRANOUS GLOMERULOPATHY

MEMBRANOUS GLOMERULOPATHY (MGN)


  • Most common in Geriatric population
primary membranous glomerulopathy:
- Antibody against Phospholipase A2 receptor (PLA2) 

Secondary membranous glomerulopathy:
  1. CONNECTIVE TISSUE DISORDER: RA/SLE/SCLERODERMA/MCTD
  2. AUTOIMMUNE DISORDERS LIKE HASHIMOTO THYROIDITIS/GRAVES
  3. INFECTION: ENTEROCOCCI ENDOCARDITIS/HBV/HCV/LEPROSY/MALARIA
  4. SOLID ORGAN TUMORS:LUNG CANCER
  5. DRUGS: PENICILLAMINE,CAPTOPRIL,MERCURY BASED COMPOUNDS



CLINICAL FEATURES:
  1. Puffy eyes - pedal edema
  2. Anasarca
  3. Hypertension


WORKUP:

  • URINE - Oral fat bodies
  • Blood urea nitrogen increased,serum creatinine increased
  • Anti nuclear antibody (ANA) ++
  • HIV/HBV/HCV
  • workup for malignancy(solid organ tumor)
  • Cryoglobulin levels
  • KIDNEY BIOPSY:
- Hyper cellularity
- polymorpho nuclear cells(PMN cells)
- C3/ IgM/igG
- Sub epithelial deposits + spikes

  • Anti phospholipase A2 antibody +++

TREATMENT:
  • Low protein diet
  • Furosemide - oedema
  • Hypertension - ACEI
  • Statins
COMPLICATIONS:
  • Renal vein thrombosis (unilateral enlarged painful kidney with AKI(acute kidney injury) features




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