Membranous nephropathy

Follow-up is as an outpatient, with major focus on blood pressure control and reduction of proteinuria. Serum urea, serum creatinine, proteinuria (measured by the ratio of urinary protein to creatinine), and electrolytes need to be measured at every visit. Liver function tests including AST and ALT should be checked periodically if the patient is on statins for hyperlipidaemia management. A fasting lipid profile should be done yearly.

Routine screening for renal vein thrombosis (Doppler, MRI, renal venography) is not recommended, but clinical evaluation of the signs and symptoms of renal vein thrombosis (flank pain, microscopic or gross haematuria with a marked elevation in serum lactate dehydrogenase), deep vein thrombosis, and pulmonary embolism is warranted. If anticoagulation is needed to treat a thrombotic complication, then warfarin should be continued for as long as the patient remains nephrotic, with a minimum duration of 6 months. The target INR is 2.0 to 3.0.

Additional follow-up and monitoring in medium- or high-risk groups is based on the pharmacological interventions. FBC with differential should be checked monthly if cyclophosphamide or chlorambucil is being prescribed.