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Membranous Nephropathy
- Howard A. Austin III, MD;
- Tatiana T. Antonovych, MD;
- Karen MacKay, MD;
- Dimitrios T. Boumpas, MD; and
- James E. Balow, MD
Abstract
▪ Membranous nephropathy is a worldwide problem that accounts for about 20% of the cases of the adult-onset nephrotic syndrome. This disease places many patients at risk for both end-stage renal failure and the complications of hyperlipidemia. Immunemediated injury to the glomerular capillary wall in patients with membranous nephropathy is characterized by subepithelial immune complex formation and generation of the membrane attack complex of complement. Glomerular capillary hypertension, hyperlipidemia, and possibly cytokines could contribute to the glomerular sclerosis seen in the advanced stages of the disorder. In some cases, production of pathogenic antibody can be suppressed by treating the underlying condition. The mechanisms of action of immunosuppressive agents are being investigated and treatments are being tested in clinical trials to optimize the balance of efficacy and toxicity. Alternate-day treatment with corticosteroids is often recommended for nephrotic patients with idiopathic membranous nephropathy, but this approach has not been proved beneficial. Ongoing studies are evaluating whether cytotoxic drugs or cyclosporin A combined with prednisone is more effective than treatment with corticosteroids alone. Lipid-lowering drug therapy is warranted in cases of the persistent nephrotic syndrome to avert the cardiovascular sequelae of hyperlipidemia.
Article and Author Information
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An edited summary of a Clinical Staff Conference held 24 April 1991 at the Clinical Center, Bethesda, Maryland. The conference was sponsored by the National Institutes of Health, United States Department of Health and Human Services.
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Authors who wish to cite a section of the conference may use this example for the form of reference:
Antonovych TT. Pathology of membranous nephropathy, pp 672-674. In: Austin HA III, moderator. Membranous nephropathy. Ann Intern Med. 1992;116:672-682.
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For current author addresses, see end of text.
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Requests for Reprints: Howard A. Austin, III, MD, National Institutes of Health, Building 10, Room 3N112, Bethesda, MD 20892.
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Current Author Addresses: Drs. Austin, Balow, Boumpas, and MacKay: Building 10, Room 3N112, National Institutes of Health, Bethesda, MD 20892.
Dr. Antonovych: Room 3055, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
