Membranous Glomerulonephritis: Treatment, Prognosis, and Emotional Impact

Glomerulonephritis

The biopsy report indicates membranous glomerulonephritis.
Prior to the biopsy, the proteinuria was 1.25 grams, which increased to 2 grams after the biopsy.
Following one month of steroid treatment, the proteinuria decreased to 1.3 grams.
Due to significant side effects from the steroids, the treatment was switched to the immunosuppressant Myfortic (mycophenolate mofetil).
Currently, the proteinuria is 0.88 grams, and the albumin level is 597.
The treatment has been ongoing for a total of 2 months.

The doctor mentioned that proteinuria can fluctuate with emotions and stress, which is indeed possible.
It is important to manage stress for overall health.

The pathological changes observed include 21 glomeruli with mild loop thickening, with 2 showing mild to marked hyperplasia.
The tubules, interstitium, and arterioles exhibit minimal changes.
Immunofluorescence microscopy revealed 10 glomeruli, with one being obsolete; the others showed 3-4+ IgG and C3 in a loop pattern.
Regarding treatment, membranous glomerulonephritis can be managed effectively, but the prognosis varies among individuals.
While some patients may experience complete recovery, others may have persistent proteinuria or progress to chronic kidney disease, which could necessitate dialysis.
It is essential to continue monitoring kidney function and protein levels closely.
Thank you, doctor!

A Hong, 30~39 year old female. Ask Date: 2013/12/21

Dr. Wu Jiyu reply Internal Medicine

Membranous nephropathy is the most common cause of nephrotic syndrome in adults, with the majority of cases being of unknown origin, while a minority are associated with medications or infections (such as hepatitis B).
Treatment and prognosis can be categorized into three types:
1.
Mild progression: Proteinuria less than 4 grams and normal kidney function.
2.
Moderate progression: Proteinuria between 4 to 8 grams.
3.
Severe progression: Proteinuria greater than 8 grams and abnormal kidney function.
The treatment goal is to achieve proteinuria less than 1 gram and to control blood pressure below 130/80 mmHg.
In addition to two specific antihypertensive medications (ACE inhibitors/ARBs), immunosuppressants are typically chosen for patients with moderate progression or higher.
Regarding prognosis, approximately 40% of patients can achieve complete remission of proteinuria, 30-50% may achieve partial remission, and only 10% will progress to abnormal kidney function.
It is recommended that you cooperate with your current physician and undergo regular check-ups to effectively manage this condition.
Thank you for your inquiry.

Sincerely, the Nephrology Department of Changhua Hospital cares about your health.

Reply Date: 2013/12/21

More Info

Membranous glomerulonephritis (MGN) is a common cause of nephrotic syndrome in adults, characterized by the presence of subepithelial immune complex deposits along the glomerular capillary walls. The pathology report you provided indicates mild loop thickening and the presence of IgG and C3 in a loop pattern, which is consistent with MGN. The treatment and prognosis of MGN can vary significantly based on the severity of proteinuria and kidney function.

Treatment Options
In your case, initial treatment with corticosteroids was attempted, but due to significant side effects, the treatment was switched to Myfortic (mycophenolate mofetil), an immunosuppressant. This is a common approach when patients cannot tolerate steroids. The goal of treatment is to reduce proteinuria to less than 1 gram per day and to manage blood pressure effectively, ideally keeping it below 130/80 mmHg.
In cases of MGN, treatment can be categorized based on the degree of proteinuria:
- Mild Progression: Proteinuria less than 4 grams with normal kidney function.

- Moderate Progression: Proteinuria between 4-8 grams.

- Severe Progression: Proteinuria greater than 8 grams with impaired kidney function.

Your current proteinuria level of 0.88 grams is a positive sign, indicating that the treatment may be effective. Regular monitoring of kidney function and protein levels is essential.

Prognosis
The prognosis for MGN varies. Approximately 40% of patients may achieve complete remission of proteinuria, while 30-50% may experience partial remission. Only about 10% of patients progress to end-stage renal disease requiring dialysis. The fact that your proteinuria has decreased significantly is encouraging, but it is essential to continue monitoring and follow-up with your healthcare provider.

Emotional Impact and Proteinuria Variability
Your doctor mentioned that proteinuria can fluctuate with emotional stress and anxiety. This is indeed true; stress can impact kidney function and overall health. The kidneys are sensitive to changes in blood pressure and fluid balance, which can be influenced by stress hormones. Therefore, managing stress through relaxation techniques, therapy, or lifestyle changes can be beneficial not only for your mental health but also for your kidney health.

Pathological Changes
The pathological findings you described show mild changes in the glomeruli, which is typical for MGN. The presence of IgG and C3 suggests an immune-mediated process, often associated with various underlying conditions, including infections, medications, or malignancies. It is crucial to identify any potential secondary causes of MGN, as this can influence treatment decisions.

Conclusion
In summary, membranous glomerulonephritis can be effectively managed with immunosuppressive therapy, and the prognosis is generally favorable, especially with early intervention. Regular follow-up with your healthcare provider is essential to monitor kidney function and adjust treatment as necessary. Additionally, managing emotional well-being can play a significant role in overall health and may help stabilize proteinuria levels. If you have concerns about the risk of dialysis, it is important to discuss these with your nephrologist, who can provide personalized guidance based on your specific situation.

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