Epidemiology of membranous glomerulonephritis: Clinical, laboratory, and management strategies

Objectives: Membranous nephropathy (MN) is probably the most common and challenging cause of nephrotic syndrome among the adult population. The objective is to study the characteristics of Omani patients with primary membranous glomerulonephritis (MGN). Material and Methods: The Royal Hospital is the only center to which all patients from all hospitals and regions of the Ministry of Health in Oman are referred for biopsy. It has an internationally recognized electronic medical record system called AL SIFFA, which utilizes the International Classification of Diseases. All clinical, laboratory, and radiological data are collected prospectively. Patients diagnosed with primary membranous nephropathy between 2007 and 2018 were studied for their clinical, laboratory, and management strategies. Results: A total of 56 patients met the inclusion criteria for clinical nephrotic syndrome and histological diagnosis of membranous glomerulonephritis (MGN). The mean (standard deviation [SD]) of age was 42.3 (12) years and was more common in the age group 24–64.5 years (90.9%), with more predominant among males 30/56 (54.6%). At presentation, most of the patients, 66%, were symptomatic for more than 3 months and had nephrotic range proteinuria in 88.6% by urine protein creatinine ratio (UPCR) and 83% by 24 h urine protein. Anti-phospholipase A2 receptor antibody was normal in 5.4% and high in 94.6%, with a mean (SD) of 46.5 (72). Rituximab was given to 32.7% of patients. Conclusion: Primary MGN is common among males. It is presented with nephrotic range proteinuria. APLA was positive in most of the cases. Rituximab has been recently added to the management strategy, along with other immunosuppressant medications. These results are consistent with global trends.