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Membranous Nephropathy (MN)

Membranous nephropathy (MN) is a kidney disease that causes injury to the small filters (glomeruli) in kidney tissue. It occurs when the person makes antibodies that damage kidney cells which form part of the kidney filters. Antibodies are proteins produced by the immune system to attack and neutralize harmful bacteria, viruses or other cells. In some cases, antibodies are produced against our own tissues (autoantibodies). The anti-phospholipase A2 receptor (anti-PLA2R) antibody causes more than 60% of cases of MN. Several other antibodies have also been identified in MN. Damage to the kidney filters results in protein leaking into the urine, can reduce the kidneys’ ability to remove waste products from the blood, and over time can irreversibly damage kidney function.

Who Gets MN

Doctors most often diagnose MN in adults, it is a rare disease in children. Most cases of MN only affect the kidneys. In about 25% of cases, Doctors can link MN with other conditions, such as:

– Cancer
– Medication side effects
– Lupus
– Viral infections

Signs and Symptoms

Some people with MN do not have symptoms. Often, doctors find the condition through routine testing that detects protein in the urine. Other patients may experience swelling and other signs of abnormal kidney function.

Common signs of MN include:

  • Fatigue 
  • Urine that looks foamy or frothy  
  • Swelling in the ankles and legs 
  • High levels of protein in the urine 
  • Low levels of protein in the blood 

Complications of the condition can occur, such as: 

  • Blood clots 
  • High cholesterol 
  • Infection 
  • Worsening kidney function 

Diagnosing MN

Your doctor uses different tests to diagnose MN. Getting the correct diagnosis is important because several kidney conditions occur with protein in the urine and swelling. 

Tests to diagnose MN include: 

  • Blood tests. These tests can identify anti-PLA2R antibodies (or other antibodies) in the blood. A diagnosis may be possible without a biopsy if these antibodies are present. 
  • Kidney biopsy. Doctors can examine kidney tissue to determine the presence of MN. A biopsy can pinpoint the underlying cause of MN, such as a specific antibody or associated condition. 
  • Urine tests. Doctors check the urine for abnormal amounts of blood and protein. 

If you are diagnosed with MN, your doctor will also check for any related conditions, such as cancer, medication side effects, lupus or viral infections.

Your Treatment Options

MN is treatable and sometimes curable if diagnosed at an early stage. Your doctor will prescribe the right care plan for you. Treatments focus on three measures: 

  • Lifestyle changes: To help control blood pressure, prevent harm to the kidneys, and reduce swelling
  • Supportive care:Your doctor may prescribe several treatments to help manage your symptoms.  
  • Immunosuppression. MN is an autoimmune condition. Treatment prevents the body from making the antibodies that damage the kidney cells. Immunosuppressive medicines target the B cells or plasma cells in the blood that produce the antibodies. These treatments have the potential to cure the disease. 

Your doctor may recommend to avoid medications that harm the kidneys (ibuprofen and NSAIDs), choosing a low-protein diet, eating a low-salt diet, exercising, limiting alcohol, and quit smoking. Your doctor may prescribe calcineurin inhibitors (cyclosporin or tacrolimus) or cyclophosphamide. Sometimes, your doctor prescribes these medicines in addition to steroids. Monoclonal antibodies are lab-made molecules that target specific cells or proteins. For MN, this therapy targets B cells or plasma cells. You can receive this therapy through an IV at an infusion center. Your doctor decides how often you need treatment. The drug Rituximab is an example.

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Clinical trials are another treatment option.

Your doctor helps you find the right study for you. These trials test more targeted treatments with potentially lower risks of side effects.

Some clinical trials enroll patients, based on their genetic testing results, to test the effectiveness of precision-based therapies targeted to specific genetic changes.

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Tips For Living With MN

Patients with MN benefit from supportive measures including:

Exercise

Regular, moderate activity helps manage your blood pressure and weight and improves your overall well-being.

Prescription Regimen

Follow your doctor’s instructions and take your medicines as prescribed.

Regular Check-Ups

See your doctor as scheduled to monitor your kidney function and quickly address any changes.

Kidney Transplant and Recurrence in MN 

If MN gets worse and causes kidney failure, dialysis or a kidney transplant can help. MN recurs in transplanted kidneys about 30% of the time. Most MN patients who get a kidney transplant enjoy successful transplants and recovery.

Support

Get help coping with the challenges of living with MN through support groups like NephCure. Learn more about our how we can support you.

Nutrition

Eat a diet low in salt and processed foods to manage your blood pressure and reduce strain on your kidneys. Learn more about a kidney-friendly diet and get our cookbook.

Your Nephrologist May Also Recommend

1

Diuretics

Diuretics are important as they help manage fluid retention and edema, which are common complications of kidney dysfunction.

2

Anticoagulants

Anticoagulants are essential for rare kidney disease patients to prevent the formation of blood clots.

3

Medications

Blood Pressure medications to lower high blood pressure. Statins to lower the cholesterol level.

4

Vitamin-D

Vitamin-D plays a crucial role in supporting overall health and mitigating potential complications.

Related Resources

Video

Membranous Nephropathy: Sharing Breakthroughs and Recent Discoveries

Informational Documents

Low Sodium Pocket Guide

Educational Materials

Kidney Biopsies

Fact Sheet

Membranous Nephropathy (MN)

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