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Membranous Nephropathy

Membranous nephropathy is a type of glomerulonephritis.

Glomerulonephritis means inflammation of the filters in the kidney -known as glomeruli. The glomeruli filter the blood as it passes through your kidneys and urine is made.

Nephropathy means disease of the kidney.

In membranous nephropathy, the glomeruli in the kidney are damaged– the membranes of the glomeruli become thickened. This results in large amounts of protein leaking from the blood into the urine. Healthy kidneys should not leak any protein in the urine.

How is membranous nephropathy diagnosed?
Membranous nephropathy is usually diagnosed by taking a small sample of the kidney (biopsy) and examining it under a microscope. More recently, a blood test called phospholipase A2 receptor antibodies (sometimes known as anti-PLA2R antibodies) has been used to diagnose patients with membranous nephropathy

What causes membranous nephropathy?

In most cases, membranous nephropathy develops for no known reason. This is called primary membranous nephropathy. 
Research suggests that this may happen when the body’s immune system makes antibodies (such as anti-PLA2R antibodies) that attack the filters in the kidney that cause the leakage of protein in the urine.In a small number of people, membranous nephropathy may be secondary to a particular trigger. These include:
• Diseases of the immune system such as systemic lupus erythematosus (SLE)
• Certain medications
• Certain cancers
• Long term (chronic) infections particularly viral hepatitis

What symptoms and complications might I expect?

Some patients with membranous nephropathy will have few symptoms. Others develop nephrotic syndrome. Nephrotic syndrome is when:
• The kidney leaks a lot of protein in the urine – usually more than 3 g in 24 hours
• The protein levels in the blood are low
• There is swelling (oedema) in the body usually in the lower legs and ankles but sometimes around the back and face
• Patients with nephrotic syndrome often have frothy urine due to the large amount of protein in the urine.
Sometimes in very severe cases of nephrotic syndrome, there is an
increased risk of developing:
• blood clots
• infections
• high cholesterol levels
• high blood pressure (hypertension)

What will happen to my kidneys in the future?

• In about one third of patients, the protein leakage into the urine goes away by itself. This is called a spontaneous remission.

• In a further one third of patients, the amount of protein leaking in the urine reduces but does not go away completely. We call this a partial remission.

• In the remaining third of patients, the amount of protein leaking into the urine does not improve and the kidney function may get worse. If this happens to you, your doctor may recommend medication to dampen your immune system to stop the kidney function from getting worse.

– Some of this group of patients will go on to get kidney failure, which does not get better. These people will need regular dialysis treatment or a kidney transplant. This happens in about 15% (15 out of 100) of patients with membranous nephropathy.
– Kidney failure usually happens about 5 - 10 years after the diagnosis of membranous nephropathy, but can happen sooner.

What can I do to stay healthy and help my kidneys?

There are a number of things you can do to help your condition:

• If you smoke you should try to stop. Your GP practice will be able to help you with this.

• You should try to keep your blood pressure well controlled, as this is very important in protecting your kidneys. You will need to buy a blood pressure machine to monitor your blood pressure at home, these can be bought from most chemists. Your doctor will tell you how often you should measure your blood pressure and what your blood pressure target should be.

• You should reduce the amount of salt in your diet, as this will help your blood pressure. Our dietician can give you advice about this as well as other changes to your diet to help control your cholesterol if it is high.

• If you have a lot of swelling (oedema) and are taking water tablets (called diuretics, such as furosemide), to reduce the swelling, it can be useful to weigh yourself regularly. Your doctor can advise you on how often you need to weigh yourself and what to do if the swelling is not improving.

• You can reduce the risk of infections by:
– having a flu vaccine every year
– having a vaccine to protect you against a common lung infection or pneumonia
– having covid vaccinations and boosters when advised.

If you are taking medications that affect your immune system, please inform your practice nurse before you have any vaccine.

• Some patients with nephrotic syndrome are at increased risk of blood clots (deep vein thrombosis or DVT). Speak to you doctor if you are planning to go on a long-haul flight.

• It is very important to use contraception and speak to your doctor before getting pregnant. If you think you are pregnant, you must speak to your kidney doctor as soon as possible. This is because your medication may need to be changed and you will need to be monitored more closely.

• Try to exercise for 30 minutes, 5 times a week. You can split this into 10 minute sessions if you tire easily.
How is membranous nephropathy treated?
You may be started on the following medication:

• Water tablets - known as diuretics (such as furosemide), to help reduce swelling

• Blood pressure tablets – known as antihypertensives (such as ramipril or candesartan), that help lower your blood pressure and reduce the amount of protein leaking into your urine

• Cholesterol tablets – known as statins (such as atorvastatin), that will lower the cholesterol in your blood

• Blood thinning tablets – known as anticoagulants (such as warfarin), that reduce the risk of developing blood clots, especially if your protein levels are very low.

• Kidney function
• Liver tests, to measure the protein levels in your blood
• Cholesterol levels
• Anti-PLA2R-antibodies
• “Protein: creatinine ratio (PCR)” or “albumin: creatinine ratio (ACR)”, to measure the amount of protein leaking in the urine.

Last reviewed May 2025
Next review May 2028

Reviewed by Dr Oshini Shivakumar 'Specialist Renal Registrar'

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.