I n t e r n a L medicine questions Bank

Membranous glomerulonephritis

Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF). It usually presents as nephrotic syndrome or proteinuria

Renal biopsy demonstrates:

• 
  sub-epithelial immune complex (mainly IgG and C3) deposition in the glomerulus
  
• 
  electron microscopy: the basement membrane is thickened with sub-epithelial electron dense deposits
  

Causes

• 
  idiopathic
  
• 
  infections: hepatitis B, malaria
  
• 
  malignancy: lung cancer, lymphoma, leukaemia
  
• 
  drugs: gold, penicillamine, NSAIDs
  
• 
  systemic lupus erythematous (class V disease)
  

Prognosis - rule of thirds

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

Management

• 
  immunosuppression: steroids, chlorambucil e.g. Ponticelli regime
  
• 
  BP control
  
• 
  consider anticoagulation
  

11. 
    Each one of the following is a recognised side-effect of erythropoietin, except:
    

	A.	Urticaria
	B.	Hypertension
	C.	Bone aches
	D.	Long bone fractures
	E.	Pure red cell aplasia