Case history
Case history #1
A 48-year-old man presents to his family physician with a recent lower-extremity swelling that is gradually worsening. Over the last few weeks, he has also noticed puffiness under his eyes. A urinalysis demonstrates significant proteinuria, and a 24-hour urine collection confirms proteinuria of 12 g. He has no history of diabetes mellitus, macroscopic hematuria, or hypertension.
Case history #2
A 30-year-old woman with a past medical history of lupus presents to her family physician with worsening lower-extremity swelling. She has no previous history of renal involvement. A urinalysis reveals 3+ protein and no blood; urinary sediment shows lipid droplets.
Other presentations
Edema is the most common presentation of membranous nephropathy causing nephrotic syndrome. However, some patients may be referred following the incidental discovery of proteinuria or abnormal renal function. Other systemic symptoms such as arthralgia, dry eyes, or a skin rash may be evident if a secondary cause is present.
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