Membranous Nephropathy: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr G Suma Rama Gopal , Nephrologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Membranous nephropathy (MN) is a kidney disease that affects the glomeruli, the tiny filtering units responsible for removing waste and excess fluid from the blood. It occurs when immune deposits accumulate along the glomerular basement membrane, causing it to thicken and leak protein into the urine. Membranous nephropathy is one of the most common causes of nephrotic syndrome in adults and can range from mild disease to progressive kidney failure if left untreated.

What Are the Types of Membranous Nephropathy?

Membranous nephropathy is classified according to its underlying cause.

Primary (Idiopathic) Membranous Nephropathy: An autoimmune disease, commonly associated with antibodies against the phospholipase A2 receptor (PLA2R) or, less commonly, THSD7A.
Secondary Membranous Nephropathy: Develops due to underlying conditions such as infections, autoimmune diseases, medications, or certain cancers.

What Are the Symptoms of Membranous Nephropathy?

Symptoms usually develop gradually and are mainly related to excessive protein loss in the urine.

Swelling of the legs, ankles, feet, or face
Foamy urine due to excess protein
Weight gain from fluid retention
Fatigue and weakness
High blood pressure
Reduced urine output in advanced disease
Loss of appetite in severe kidney impairment

What Causes Membranous Nephropathy?

Membranous nephropathy may occur as a primary autoimmune disorder or develop secondary to other medical conditions.

Autoimmune antibodies targeting kidney structures (primary MN)
Hepatitis B and hepatitis C infections
Lupus and other autoimmune diseases
Certain medications, including NSAIDs and gold-containing drugs
Underlying cancers such as lung, colon, or breast cancer

When Should You See a Doctor for Membranous Nephropathy?

You should consult a nephrologist if you develop symptoms suggestive of kidney disease or persistent protein in the urine.

Seek medical evaluation if you experience:

Persistent swelling of the legs, feet, or face
Foamy urine
Unexplained weight gain due to fluid retention
High blood pressure
Persistent fatigue or weakness
Abnormal kidney function or urine test results

Early diagnosis and treatment can reduce protein loss, preserve kidney function, and prevent long-term complications.

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How Is Membranous Nephropathy Diagnosed?

Diagnosis combines laboratory tests with kidney biopsy to confirm the condition and identify its cause.

Urinalysis and urine protein measurement
Blood tests to assess kidney function
Blood tests for PLA2R antibodies and other autoimmune markers
Screening for infections and underlying diseases
Kidney ultrasound
Kidney biopsy to confirm the diagnosis

How Is Membranous Nephropathy Treated?

Treatment depends on the severity of proteinuria, kidney function, and whether the disease is primary or secondary.

ACE inhibitors or angiotensin receptor blockers (ARBs) to reduce proteinuria
Immunosuppressive therapy for high-risk or progressive disease
Corticosteroids in selected treatment regimens
Rituximab, cyclophosphamide, or calcineurin inhibitors when appropriate
Diuretics to control swelling
Treatment of the underlying condition in secondary membranous nephropathy
Kidney-friendly diet and lifestyle modifications

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What Are the Risk Factors for Membranous Nephropathy?

Several factors increase the likelihood of developing membranous nephropathy.

Autoimmune diseases
Chronic hepatitis B or hepatitis C infection
Certain medications
Underlying malignancies
Older age, particularly for primary membranous nephropathy

What Complications Can Membranous Nephropathy Cause?

Persistent protein loss and declining kidney function may lead to several serious complications.

Nephrotic syndrome
Chronic kidney disease
Kidney failure
Blood clots (thromboembolism)
High cholesterol levels
Persistent high blood pressure

Can Membranous Nephropathy Be Prevented?

Primary membranous nephropathy cannot usually be prevented because it is an autoimmune condition. However, secondary membranous nephropathy may be prevented or its progression reduced by treating infections promptly, managing autoimmune diseases effectively, avoiding unnecessary kidney-toxic medications, controlling blood pressure, following a kidney-friendly diet, quitting smoking, and attending regular follow-up appointments.

What Is the Prognosis for Membranous Nephropathy?

The prognosis varies depending on the degree of proteinuria, kidney function, and response to treatment. Some individuals experience spontaneous remission, while others develop progressive kidney disease over several years. Early diagnosis, appropriate immunosuppressive therapy when indicated, careful blood pressure control, and long-term nephrology follow-up significantly improve the chances of preserving kidney function and achieving favorable outcomes.