What is seen on electron microscopy in Membranous glomerulonephritis?

the basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance

What is the management of Membranous glomerulonephritis?

• all patients should receive an ACE inhibitor or an angiotensin II receptor blocker
• immunosuppression (only for severe or progressive disease)
• consider anticoagulation for high-risk patients

What are the main causes of Membranous glomerulonephritis?

• idiopathic: due to anti-phospholipase A2 antibodies
• infections: hepatitis B, malaria, syphilis
• malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
• drugs: gold, penicillamine, NSAIDs
• autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

What is the prognosis of Membranous glomerulonephritis?

rule of thirds

• one-third: spontaneous remission
• one-third: remain proteinuric
• one-third: develop ESRF

How common is Membranous glomerulonephritis?

commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF)

What's the commonest presentation of Membranous glomerulonephritis?

nephrotic syndrome or proteinuria