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==Overview==
==Overview==


Common complications of membranous glomerulonephritis include renal failure.
The symptoms of membranous glomerulonephritis usually develop in the fourth decade of life in males. Approximately 5-30% patients with MN have spontanous remission. Common complications of membranous glomerulonephritis include [[renal failure]], [[hypertension]], [[proteinuria]], [[dyslipidemia]], [[hypercoagulable state]] leading to [[thromboembolism]], Increased risk of [[infection]]. Prognosis is generally good, and 1 year [[mortality rate]] of patients with membranous glomerulonephritis is approximately 0.38%. The presence of [[proteinuria]] and baseline [[renal insuffiency]] are  associated with a particularly poor prognosis among patients with membranous glomerulonephritis. Membranous glomerulonephritis caused by [[NSAIDS]] is associated with the most favorable prognosis.  


===Natural History===
==Natural History==
*The symptoms of Membranous glomerulonephritis usually develop in the fourth decade of life in males. <ref name="pmid20378220">{{cite journal |vauthors=Glassock RJ |title=The pathogenesis of idiopathic membranous nephropathy: a 50-year odyssey |journal=Am. J. Kidney Dis. |volume=56 |issue=1 |pages=157–67 |date=July 2010 |pmid=20378220 |doi=10.1053/j.ajkd.2010.01.008 |url=}}</ref> <ref name="pmid24715030">{{cite journal |vauthors=Debiec H, Ronco P |title=Immunopathogenesis of membranous nephropathy: an update |journal=Semin Immunopathol |volume=36 |issue=4 |pages=381–97 |date=July 2014 |pmid=24715030 |doi=10.1007/s00281-014-0423-y |url=}}</ref>
*The natural history of membranous glomerulonephritis (MN) is given below:<ref name="pmid11132040">{{cite journal |vauthors=Kerjaschki D |title=Pathogenetic concepts of membranous glomerulopathy (MGN) |journal=J. Nephrol. |volume=13 Suppl 3 |issue= |pages=S96–100 |date=2000 |pmid=11132040 |doi= |url=}}</ref><ref name="pmid8510707">{{cite journal |vauthors=Schieppati A, Mosconi L, Perna A, Mecca G, Bertani T, Garattini S, Remuzzi G |title=Prognosis of untreated patients with idiopathic membranous nephropathy |journal=N. Engl. J. Med. |volume=329 |issue=2 |pages=85–9 |date=July 1993 |pmid=8510707 |doi=10.1056/NEJM199307083290203 |url=}}</ref>
*The symptoms of membranous glomerulonephritis typically develop in young women increases the susceptibility of lupus.  
**The symptoms of MN usually develop in the fourth decade of life in males.
**The presence of symptoms of MN young female is suggestive of lupus.
**Approximately 5-30% patients with MN have spontanous remission.


===Complications===
==Complications==
*Common complications of membranous glomerulonepharitis include:
*Common complications of membranous glomerulonepharitis include:<ref name="pmid24715030">{{cite journal |vauthors=Debiec H, Ronco P |title=Immunopathogenesis of membranous nephropathy: an update |journal=Semin Immunopathol |volume=36 |issue=4 |pages=381–97 |date=July 2014 |pmid=24715030 |doi=10.1007/s00281-014-0423-y |url=}}</ref><ref name="pmid23689576">{{cite journal| author=Barbour S, Reich H, Cattran D| title=Short-term complications of membranous nephropathy. | journal=Contrib Nephrol | year= 2013 | volume= 181 | issue=  | pages= 143-51 | pmid=23689576 | doi=10.1159/000349976 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23689576  }}</ref>
**Renal failure
**[[Renal failure]]
**Symptoms associated with the nephrotic syndrome:
***[[Hypertension]]
***[[Proteinuria]]
***[[Edema]]
***[[Dyslipidemia]].
**[[Hypercoagulable state]] leading to [[thromboembolism]]
**Increased risk of [[infection]]


===Prognosis===
==Prognosis ==
* Spontaneous remission is most likely in women, children, those with lesser amounts of proteinuria, and adults under age 50 years with a normal serum creatinine concentration and benign histologic features.
* The prognostic  factors of membranous glomerulonephritis are given below:<ref name="pmid10495797">{{cite journal |vauthors=Wasserstein AG |title=Membranous glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=8 |issue=4 |pages=664–74 |date=April 1997 |pmid=10495797 |doi= |url=}}</ref><ref name="McGroganFranssen2010">{{cite journal|last1=McGrogan|first1=A.|last2=Franssen|first2=C. F. M.|last3=de Vries|first3=C. S.|title=The incidence of primary glomerulonephritis worldwide: a systematic review of the literature|journal=Nephrology Dialysis Transplantation|volume=26|issue=2|year=2010|pages=414–430|issn=0931-0509|doi=10.1093/ndt/gfq665}}</ref>
* Although unproven, the rate of partial remission may be higher with the use of ACE inhibitors or ARBs.<ref name="pmid11132040">{{cite journal |vauthors=Kerjaschki D |title=Pathogenetic concepts of membranous glomerulopathy (MGN) |journal=J. Nephrol. |volume=13 Suppl 3 |issue= |pages=S96–100 |date=2000 |pmid=11132040 |doi= |url=}}</ref>
** Prognosis is generally good, and 1 year [[mortality rate]] of patients with membranous glomerulonephritis is approximately 0.38%.
* Probability of progression — Based upon a study of 184 patients identified through the Toronto Glomerulonephritis Registry, a semiquantitative algorithm has been developed to predict the probability of progression to chronic kidney disease, which was defined as a creatinine clearance ≤60 mL/min per 1.73 m2.
** Depending on the extent of the membranous glomerulonephritis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
* The probability of progression was assessed for those with 4, 6, and 8 g/day of proteinuria that persisted for 6, 9, 12, or 24 months.  
** The presence of [[proteinuria]] and baseline [[renal insuffiency]] are associated with a particularly poor prognosis among patients with membranous glomerulonephritis.
* Multiple additional variables (including age, sex, serum creatinine, and creatinine clearance on presentation, serum albumin, presence of hypertension, rate of change of creatinine clearance, and therapy) were also tested to determine whether the predictive value provided by proteinuria could be improved. Of these variables, the initial creatinine clearance and the rate of change of clearance were the most useful predictors.
** Membranous glomerulonephritis caused by [[NSAIDS]] is associated with the most favorable prognosis.
 
** The prognosis of membranous glomerulonephritis associated with [[hepatitis B]] has less favorable prognosis.
=== Based upon this approach, the best fitting logistic model utilized the following clinical characteristics: ===
''●Persistent proteinuria for over six months'' 
 
''●Creatinine clearance upon presentation'' 
 
''●Slope of the decline in creatinine clearance over the assessed proteinuria period  The addition of renal pathology as a variable had no effect on the performance of the model.''
 
''●The risk increases to 72 percent in the patient with proteinuria of 12 g/day, and a creatinine clearance on presentation of 96 mL/min, which declines to 78 mL/min by six months.
 
===   ●Low risk – ===
<nowiki>*</nowiki> ''Proteinuria remains less than 4 g/day and creatinine clearance remains normal for a six-month follow-up period''.
 
<nowiki>*</nowiki>Such patients have a less than 8 percent risk of developing chronic renal insufficiency over five years.
 
===  ●Moderate risk – ===
''Proteinuria is between 4 and 8 g/day and persists for more than six months. Creatinine clearance is normal or near normal and remains stable over six months of observation''
 
''. Chronic renal insufficiency develops over five years in approximately 50 percent of these patients.''
 
=== ●High risk – ===
 
●Acute bilateral renal vein thrombosis which may be associated with flank pain.  
 
●Drug-induced acute interstitial nephritis, in which white cell, white cell casts, and possibly eosinophils are typically seen in the urine sediment.  
 
●Superimposed crescentic glomerulonephritis, in which red cells and cellular casts are found in the urine sediment.
 
===  Secondary MN — ===
* In patients with secondary MN, cessation of the offending drug (eg, penicillamine, gold, or nonsteroidal anti-inflammatory drug) or effective treatment of the underlying disease is usually associated with improvement in the nephrotic syndrome.  
 
* With penicillamine- or gold-associated disease, protein excretion may continue to rise for the first 1 to 12 months (mean 2 months) after the offending drug has been discontinued.


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2]

Overview

The symptoms of membranous glomerulonephritis usually develop in the fourth decade of life in males. Approximately 5-30% patients with MN have spontanous remission. Common complications of membranous glomerulonephritis include renal failure, hypertension, proteinuria, dyslipidemia, hypercoagulable state leading to thromboembolism, Increased risk of infection. Prognosis is generally good, and 1 year mortality rate of patients with membranous glomerulonephritis is approximately 0.38%. The presence of proteinuria and baseline renal insuffiency are associated with a particularly poor prognosis among patients with membranous glomerulonephritis. Membranous glomerulonephritis caused by NSAIDS is associated with the most favorable prognosis.

Natural History

  • The natural history of membranous glomerulonephritis (MN) is given below:[1][2]
    • The symptoms of MN usually develop in the fourth decade of life in males.
    • The presence of symptoms of MN young female is suggestive of lupus.
    • Approximately 5-30% patients with MN have spontanous remission.

Complications

Prognosis

  • The prognostic factors of membranous glomerulonephritis are given below:[5][6]
    • Prognosis is generally good, and 1 year mortality rate of patients with membranous glomerulonephritis is approximately 0.38%.
    • Depending on the extent of the membranous glomerulonephritis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
    • The presence of proteinuria and baseline renal insuffiency are associated with a particularly poor prognosis among patients with membranous glomerulonephritis.
    • Membranous glomerulonephritis caused by NSAIDS is associated with the most favorable prognosis.
    • The prognosis of membranous glomerulonephritis associated with hepatitis B has less favorable prognosis.

References

  1. Kerjaschki D (2000). "Pathogenetic concepts of membranous glomerulopathy (MGN)". J. Nephrol. 13 Suppl 3: S96–100. PMID 11132040.
  2. Schieppati A, Mosconi L, Perna A, Mecca G, Bertani T, Garattini S, Remuzzi G (July 1993). "Prognosis of untreated patients with idiopathic membranous nephropathy". N. Engl. J. Med. 329 (2): 85–9. doi:10.1056/NEJM199307083290203. PMID 8510707.
  3. Debiec H, Ronco P (July 2014). "Immunopathogenesis of membranous nephropathy: an update". Semin Immunopathol. 36 (4): 381–97. doi:10.1007/s00281-014-0423-y. PMID 24715030.
  4. Barbour S, Reich H, Cattran D (2013). "Short-term complications of membranous nephropathy". Contrib Nephrol. 181: 143–51. doi:10.1159/000349976. PMID 23689576.
  5. Wasserstein AG (April 1997). "Membranous glomerulonephritis". J. Am. Soc. Nephrol. 8 (4): 664–74. PMID 10495797.
  6. McGrogan, A.; Franssen, C. F. M.; de Vries, C. S. (2010). "The incidence of primary glomerulonephritis worldwide: a systematic review of the literature". Nephrology Dialysis Transplantation. 26 (2): 414–430. doi:10.1093/ndt/gfq665. ISSN 0931-0509.

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