Membranous nephropathy
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Membranous nephropathy
Pathology
Renal and ureteral disorders
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Minimal change disease
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Renal system pathology review
Congenital renal disorders: Pathology review
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
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Membranous nephropathy
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Reproduced from: Wikipedia
Which of the following is most suggestive of this patient’s underlying diagnosis?
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Membranous nephropathy p. 618, 619, 723
membranous nephropathy, primary
autoantibody p. 113
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Content Reviewers
Rishi Desai, MD, MPHContributors
Tanner Marshall, MS
Membranous glomerulonephritis, also known as membranous nephropathy, is where the glomerular basement membrane, or GBM, which lines the glomeruli in the kidney, becomes inflamed and damaged, which results in increased permeability and proteins being able to filter through into the urine, causing nephrotic syndrome.
But what exactly is nephrotic syndrome? Well usually the glomerulus only lets small molecules, like sodium and water, move from the blood into the kidney nephron, where it eventually makes its way into the urine. But with nephrotic syndromes, the glomeruli are damaged and they become more permeable, so they start letting plasma proteins come across from the blood to the nephron and then into the urine, which causes proteinuria, typically greater than 3.5 grams per day.
An important protein in the blood is albumin, and so when it starts leaving the blood, people get hypoalbuminemia—low albumin in the blood.
With less protein in the blood the oncotic pressure falls, which lowers the overall osmotic pressure, which drives water out of the blood vessels and into the tissues, called edema.
Finally, it’s thought that as a result of either losing albumin or losing some protein or proteins that inhibit the synthesis of lipids, or fat, you get increased levels of lipid in the blood, called hyperlipidemia.
Just like the proteins, these lipids can also get into the urine, causing hyperlipiduria.
And those are the hallmarks of nephrotic syndrome—proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria.
Alright, so with membranous glomerulonephritis, the basement membrane becomes damaged which causes nephrotic syndrome. How does this happen, though? Well, ultimately this damage is caused by immune complexes—complexes composed of an antigen with an antibody bound to it.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Membranous nephropathy in children: clinical presentation and therapeutic approach" Pediatric Nephrology (2009)
- "Thrombospondin Type-1 Domain-Containing 7A in Idiopathic Membranous Nephropathy" New England Journal of Medicine (2014)
- "Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome" Cochrane Database of Systematic Reviews (2014)
- "Membranous Glomerulopathy: Emphasis on Secondary Forms and Disease Variants" Advances in Anatomic Pathology (2001)
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