Management of membranous nephropathy

The management of membranous nephropathy first requires the recognition of whether the disorder is primary (idiopathic) or secondary. Next, a familiarity with its natural history and knowledge of our current capacity to predict those patients with the worst outcome is reviewed. Treatment options of those at risk of progression with immunosuppressive drugs is then discussed along with the required accompaniment of risk reduction strategies including idealization of the blood pressure, the use of angiotensin enzyme inhibitor therapy and perhaps dietary protein restriction. As well treatment directed at other complications of the disease process including the hyperlipidemia and hypercoagulability are considered as part of the management to reduce risks. Lastly, therapies directed towards preventing or reducing the complications of immunosuppressive drugs such as trimethoprim-sulfamethoxazole prophylaxis against pneumocystis carini pneumonia and biphosphonates to reduce bone mass loss from corticosteroid therapy are discussed.