Chapter 16
Membranous Nephropathy
Katie Trinh,
Bhadran Bose,
Katie Trinh
Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorBhadran Bose
Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorKatie Trinh,
Bhadran Bose,
Katie Trinh
Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorBhadran Bose
Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
Membranous nephropathy is a chronic disease, with spontaneous remission and relapses. Because of its high incidence rate, membranous nephropathy remains the second or third leading cause of end-stage kidney disease among the primary glomerulonephritistypes. Patients are assigned to nonimmunosuppressive therapy or to immunosuppressive therapy according to their risk for renal disease progression. This chapter summarizes Grading of Recommendation, Assessment, Development, and Evaluation recommendations for treatment of membranous nephropathy. It presents the different risk groups for progressive decline in kidney function. The control of nephrotic syndrome, specifically with complete remission or partial remission, is strongly associated with renal survival and a slower rate of chronic kidney disease progression. In patients who are at low-risk of progression, therapy focused on blood pressure lowering should suffice, although long-term follow-up is needed to ensure that there is no disease progression or worsening of proteinuria. Patients at medium-risk or high-risk are candidates for additional immunosuppressive therapy.
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