Membranöse Glomerulonephritis - Pathogenese und Therapie

Membranous nephropathy is the leading cause of the nephrotic syndrome in adults. The diagnosis of idiopathic membranous nephropathy can be made in 70-80 % of the cases. In the other cases, a secondary cause, such as malignancies, lupus erythematodes, virus hepatitis or medication can be found. The idiopathic membranous nephropathy has an autoimmune pathogenesis in which the recently discovered phospholipase A 2 receptor antibody possibly plays a central role. The symptomatic treatment of membranous nephropathy consists of ACE-inhibitors and/or ATI-blockers, which are helpful in treating proteinuria. An immunosuppressive medication should be started if there are risk factors for loss of renal function, large proteinuria (> 8 g/24 h) or renal function deterioration. The most extensive data exist on the treatment with alkylating agents or ciclosoporine A. The role of new treatment options such as rituximab is being currently investigated.