How To Improve Prognosis of Membranous Nephropathy

Membranous nephropathy is one common cause of nephrotic syndrome in adults. The majority of patients have the symptoms of nephrotic syndrome, 20% patients can only have proteinuria and about 17%-50% patients have high blood pressure, some patients can also have microscopic hematuria and impairments of renal functions.

High blood pressure, renal impairment and proteinuria especially when they are not well controlled with medicines often indicate poor prognosis. Besides, the patient’s age, gender, severity and duration of proteinuria are all closely related to the prognosis of the disease.

The following aspects can help membranous nephropathy patients achieve a better prognosis.

For those that have 24-h urine protein less than 3.5g/d with normal or mild renal damages, nephrologists propose the following four suggestions for improving the prognosis.

1. Well control of high blood pressure. It is better to control blood pressure within in 125/70mmHg or below. The first preferred drugs are ACEI and ARB.

2. Anti-coagulation. Membranous nephropathy patients are at high risk of developing venous thrombus especially those that have daily urine protein higher than 8g, serum albumin lower than 20g/l, long term intake of diuretics, early prevention is very necessary.

3. Low-protein diets. The prognosis of membranous nephropathy has much to do with the severity and duration of proteinuria. A low-protein diet can help ease proteinuria, reduce burdens to the kidneys and protect residual kidney functions. Daily protein intake should be controlled within 0.8g per kg body weight.

4. Others include early and effective treatment for swelling, hyperlipidemia and other symptoms and complications.

For those that have massive proteinuria (24-h urine protein higher than 3.5g). Early treatment with immunosuppressants is necessary which can help lower proteins in urine, reduce complications, slow down illness progression and improve prognosis of membranous nephropathy. Immunosuppressant therapies for membranous nephropathy patients include steroids, cytotoxic drugs and immunosuppressive agents.

At the same time, Chinese medicines can be added after consulting professional doctors. Proper supplement of Chinese medicines can help reduce the side effects of immunosuppressant drugs and gradually improve kidney functions.