|Acute Kidney Injury (AKI) / Acute Renal Failure
|Chronic Kidney Disease (CKD)
|Anaemia in Chronic Kidney Disease
|Medullary Sponge kidney
|IgA Nephropathy (Berger's disease)
|HIV associated nephropathy (HIVAN)
|Balkan endemic nephropathy (BEN)
|Autosomal Dominant Polycystic kidney disease
- Causes 25% of cases of GN
- Thickening of the GBM
- Membranous glomerulonephritis is an antibody-mediated disease in which the immune complexes localise to the subepithelial aspect of the capillary loop, between the outer aspect of the GBM and the podocyte (epithelial cell).
- The immune complexes develop in situ or, less likely, by the deposition of circulating immune complexes.
- The antibody may bind to an intrinsic glomerular antigen or to an exogenous antigen planted on the capillary wall.
- Idiopathic 80%, Systemic disease : Diabetes mellitus, SLE, Sarcoid
- Drugs: Gold, NSAIDs, Captopril, mercury, heavy metals, penicillamine
- Infection: Hepatitis B, syphilis, quartan malaria, leprosy, schistosomiasis
- Malignancy: Lung, colon, breast, Prostate, Ovarian, Lymphoproliferative, Carcinoma, melanoma, leukaemia, non-Hodgkin's lymphomas.
- Membranous GN commoner in adults > 30 years at diagnosis.
- Nephrotic syndrome +/- Thrombosis
- Dipstick: Blood and protein
- 24 hour protein collection: Nephrotic levels, Haematuria
- ? Creatinine
- Renal Biopsy - granular subepithelial IgG
- CXR ? lung lesion, Colonoscopy ? colon cancer, Mammogram
- Treat cause if possible. Warfarin/Heparin as high risk of Venous thrombosis
- Immunosuppression : Steroids/Ciclosporin/Cyclophosphamide
- Some remit but others go on to gradual renal failure needing renal replacement