Journal
ADVANCES IN CHRONIC KIDNEY DISEASE
Volume 26, Issue 5, Pages 393-403Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ackd.2019.08.009
Keywords
Systemic lupus erythematosus; Lupus nephritis; Membranous lupus nephritis; Class V lupus nephritis
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Funding
- EMD-Serono
- Aurinia Pharmaceuticals
- Mallinckrodt Pharmaceuticals
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Membranous lupus nephritis (MLN) (Class V lupus nephritis [LN]) is a distinct form of LN defined by the presence of subepithelial immune complex deposits seen on kidney biopsy. MLN is often associated with the nephrotic syndrome. The histology of MLN closely resembles that of idiopathic (primary) membranous nephropathy (pMN). However, MLN typically has abundant mesangial deposits that are absent in primary membranous nephropathy. The clinical presentation, management, and prognosis of MLN differ from that of the proliferative forms of LN (Class III, IV, or Mixed III/IV + V). Although immunosuppressive therapy is often warranted in MLN, the optimal treatment regimen remains unclear. Here we describe the clinical presentation, histologic features, and natural history of MLN. We also review the role of supportive treatment and discuss when to deploy immunosuppressive management in MLN. (C) 2019 by the National Kidney Foundation, Inc. All rights reserved.
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