Membranous Nephropathy

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Summary1)Fundamentals of Pathology by Hussain Sattar

Membranous Nephropathy is the most common cause of nephrotic syndrome in Caucasian adults.

Pathophysiology2)Membranous Glomerulonephritis (Wikipedia)

Diagram of pathogenesis of Membranous Nephropathy (UNC Healthcare Kidney Center)

The cascade start with 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 C5b – C9 complements, which form a membrane attack complex (MAC) on the glomerular epithelial cells. This, in turn, stimulates release of proteases and oxidants by the mesangial and epithelial cells, damaging the capillary walls and causing them to become “leaky”. In addition, the epithelial cells also seem to secrete an unknown mediator that reduces nephrin synthesis and distribution.

Causes3)Fundamentals of Pathology by Hussain Sattar

  • Mostly Idiopathic but associated with Hepatitis B or C, solid tumors, SLE or drugs

Symptoms 4)First Aid for the Basic Sciences: Organ Systems by Tao Le

  • Insidious onset of nephrotic syndrome

Histology – Prominent glomerular basement membrane spikes (Wikipedia)

Diagnosis 5)First Aid for the Basic Sciences: Organ Systems by Tao Le

  • Renal Biopsy – diffuse GBM thickening, and subepithelial deposits in a pike and dome pattern

Treatment 6)First Aid for the Basic Sciences: Organ Systems by Tao Le 7)Fundamentals of Pathology by Hussain Sattar

  • Poor Response to Steroids
  • Cyclosphamide and Cyclosporine
  • Transplantation

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