Living with Membranous Nephropathy

Membranous nephropathy is a diagnosis term in pathological morphology. Characteristic pathological change in membraneous nephropathy is deposition of large amount of immune complexes in the epithelial side of glomerular capillary loop.

It is more common among those that are above their 40s. Most patients begin with the symptoms of nephrotic syndrome and there are about 20% patients have asymptomatic proteinuria.

There are great difference on the natural illness course and there can be 3 kinds of prognosis---spontaneous remission, persistent proteinuria with stable kidney functions, persistent proteinuria with progressive decline of kidney functions.

If the patients only have asymptomatic proteinuria and their kidney functions are still normal, non-specific treatment can be offered. For those that have massive proteinuria, early immunosuppressive treatments are necessary which can help reduce proteinuria, alleviate complications and slow down worsening rate of kidney functions.

Non-specific therapies

They are suitable for young patients that have normal kidney functions, normal or slightly lowered plasma albumin and urinary protein less than 3.5g/d.

Controlling blood pressure: blood pressure should be below 125/70mmHg. Medicines can include ACEI and ARB.

Anti-coagulation: there is high incidence of venous thrombus in membraneous nephropathy, therefore preventive anti-coagulation is necessary especially if patients have long term hypoproteinemia.

Low-protein diets: those that have massive proteinuria should limit daily protein intake within 0.8g/kg.

Others: including edema and hyperlipemia, etc.

Immune therapy

The application of immunosuppressant depends on severity and duration of proteinuria as well as kidney functions. Generally speaking, immune therapy should be given in case of proteinuria more than 3.5g/d with decline of renal functions.

Single use of hormones usually proves to be ineffective and the combination of hormones and cytotoxic drugs can help some patients achieve clinical remission. The commonly prescribed medicines include prednison, cydosporine A, tripterygium glucosides, tacrolimus and rituxan, etc.