| For a better understanding of MGN, please review Proteinuria first. |
What is it?
Who will be affected?
What are the symptoms?
What is the Natural course?
What is the Treatment?
Most of the time Membranous Glomerulonephritis (MGN) is a primary disease of the kidney. (Not secondary to another disease in the patient.) The kidneys are 'inflamed' and leak abnormal quantities of protein into the urine (Proteinuria) causing Nephrotic-Syndrome.
On occasion it could be a secondary disease of the kidneys due to other illnesses. Following is the list of some of the illnesses that could cause MGN:
| Cancers: | Lung, Colon, Breast, Stomach, Lymphoma, Leukemia, Other |
| Medications: | Gold, Mercury, Penicillamine, Captopril, Fenoprofen |
| Infections: | Hepatitis B, Hepatitis C, Malaria, Leprosy |
| Immunologic Disorders: | Lupus, Rheumatoid Arthritis, Mixed Connective Tissue Disorder, Host versus Graft reactions in patients with organ transplants |
| Familial and Metabolic: | Diabetes Mellitus, Sickle Cell Disease, Thyroiditis |
| Other: | Sarcoidosis, Vasculitis, Inflammatory Bowel Disease |
* Rare in children
* 80% to 90%
of patients are older than 30 yrs
* Common
cause of Proteinuria in adults
1. May not have any symptoms or may have one or
more of the following
2.
Fatigue
3.
Frothy urine
4.
Puffiness of face especially on waking up
5.
Swelling of legs (edema)
6.
Excessive flatulence and distention of the belly
7.
Shortness of breath especially on lying down
8.
Other symptoms depending on the cause (if any) of MGN
9.
Symptoms of complications of MGN:
Infections
Formation of Blood clots in the veins (DVT)
Heart Failure
* May resolve on its own without any treatment in up to 1/3 of patients.
Such spontaneous resolution, however, might take several years.
* Overall has adverse prognosis, with up to 1/3 of patients loosing kidney
function
requiring dialysis or kidney transplant.
* No clinically proven
treatment is currently available, although several medications
are being used with different rates of success.
Treatment:
(For a better understanding of the treatment
Please review the treatment of Proteinuria)
1. If the quantity of protein in the urine is less than 1500 mgs per 24
hrs
and blood protein level is normal with no symptoms, patients could be
observed without any treatment for several months. If the protein in the
urine does not resolve during such observation, in order to prevent long
term dangers of
proteinuria, patients may be treated.
2. Treatment involves:
a. Treatment of high blood pressure (Hypertension) if present
b. Treatment of the swelling with Diuretics and salt diet
c. Some of the Medications that are being used with various rates of
success are:
Cyclosporin
Chlorambucil
Cytoxan
ACE-inhibitors AT1-receptor
blockers Imuran
Cellcept
d. Treatment of complications of MGN
e. If MGN is secondary to a systemic illness, successful
treatment
of such primary illness could result in resolution of MGN.
ud0001212