Membranous glomerulonephritis

- characterised by subepithelial deposits of immune complexes in glomerular basement membrane
- typically seen in the over 40 age group with a male predominance of 2:1
- majority are idiopathic and manifest as nephrotic syndrome
- associations
  malignancy (non Hodgkin lymphoma, solid organ tumor)
  autoimmune (SLE, RA)
  infections (hepatitis B, malaria)
  drugs (penicillamine, gold, captopril)
- renal biopsy: thickened GBM and granular IgG and C3 on immunostaining
- 1/3 rapid decline, 1/3 responds to steroids and chlorambucil, 1/3 remit spontaneously
- treatment: low salt diet, fluid restriction, ACE inhibitor, steroids