Membranous glomerulonephritis: causes of development, symptoms and treatment
Membranous glomerulonephritis is a lesion in the body, which is characterized by the appearance of uneven electron-dense deposition of proteins of intermittent structure along the outer side of the walls of the glomerular capillaries.
This pathology is referred to as a membrane nephropathy and can affect the human body regardless of its age, but more often the pathology is diagnosed in adults aged 30 to 50 years than in children. In addition, the disease more often affects the male and proceeds in a more severe form.
In an adult human development of membranous glomerulonephritis becomes the most common cause of nephrotic syndrome formation.
Etiology of
The primary idiopathic form of membranous glomerulonephritis is found in 30 to 50% of cases of primary nephrotic syndrome in adults and only in 15% of cases in children.
Secondary form of membranous glomerulonephritis develops due to various pathologies, such as:
- Infection of the body with infections - syphilis, chronic hepatitis B, malaria, etc.
- Pathologies of rheumatic character.
- The presence of neoplasms, for example, carcinoma of the intestine, lung, mammary glands, kidney or stomach, as well as leukemia.
- Drug therapy - such as mercury, gold, and others.
In the early stages of the development of the disease, normal blood pressure values, satisfactory glomerular filtration rate, and urine sediment do not change. Subsequently, the presence of different types of proteins is diagnosed in the urine.
Often, membranous glomerulonephritis affects patients with systemic lupus erythematosus, chronic infectious pathologies, tumorous neoplasms, or when certain medicinal products affect the human body. Also, with the development of the disease, there is a high risk of formation of thrombosis in the renal veins.
The course of the pathology of
Membranous glomerulonephritis has a relatively favorable course, especially in female representatives, unexpected remissions may occur, and renal failure occurs only in 50% of cases.
Approximately 20-30% of cases can be achieved by spontaneous remission, also stable proteinuria of varying severity is formed in 20-30% cases, in other cases pathology will progress to the terminal stage within five years.
The effect on the course of membranous glomerulonephritis is complicated. They cause impairment of kidney function - there may be vein thrombosis in the kidneys or arterial thrombosis. Treatment with diuretics provokes worsening of renal circulation and development of arterial hypertension.
Treatment of
The process of treating membranous glomerulonephritis differs significantly for patients with and without nephrotic syndrome.
Patients without development of a nephrotic syndrome and with preservation of normal work of kidneys do not need the organization of immunosuppressive treatment, because the risks of formation of a deficiency in the kidneys remain minimal, in addition there is no danger of development of complications that are related to a nephrotic syndrome. Such patients should be under the constant supervision of a specialist with a view to timely diagnosing increases in blood pressure and proteinuria.
Spontaneous remission of the disease in the presence of nephrotic syndrome is often formed in children, and in adults only in 20-25% of cases of the disease. Treatment with steroid drugs often does not help achieve the establishment of a complete long-term remission, but it helps reduce the manifestations of proteinuria, reduce the rate of progression of kidney failure.
Slow, but progressive deterioration in kidney function is formed in almost all patients with persistent proteinuria. Within ten years after the diagnosis, 35 to 50% of patients die from complicating the disease or because of terminal kidney failure. Often, even after surgery, a relapse of membranous glomerulonephritis occurs in transplants.
The main methods of treatment of membranous glomerulonephritis are:
- Compliance with the diet under number 7.
- Glucocorticoid therapy that helps reduce the manifestations of proteinuria, but can contribute to the development of remission. Initially, patients are prescribed Prednisolone, after 6 to 8 weeks the dose of the drug is reduced by half, and the subsequent reduction is carried out every week until complete cancellation.
- Possible intermittent therapy with cytostatics and glucocorticoids.
- For three days in each month, pulse therapy with methylprednisolone is carried out, and the rest of the days shows the intake of prednisolone inside.
- In the second and third months of treatment, chlorbutin is prescribed.
- In the fourth month, an identical therapy is treated in the first month.
- Treatment at the fifth and sixth months coincides with therapy on the second and third.
- In the absence of expected results from the described treatment, cyclosporine is administered.
Patients with nephrotic syndrome develop a hypercoagulable state, and the risk of a clot in the renal veins or arteries remains.
Treatment with diuretics can provoke impairment of blood flow in the kidneys, in addition, blood coagulability increases, and this process can also provoke vein thrombosis in the kidneys. Patients should be regularly examined by a specialist for the timely detection of deterioration of health status and taking measures for its normalization.