Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New or follow-up for membranous nephropathy
(Specify) Proteinuria (foamy urine), microscopic hematuria (blood in urine found only on microscopy), fatigue, swelling (edema)
History of Present Illness:
For new patients, describe the onset, duration, and severity of symptoms suggestive of membranous nephropathy.
For follow-up visits, inquire about any new or worsening symptoms since the last encounter.
Mention any recent changes in medications, illnesses, or exposures.
Past Medical History:
Underlying conditions potentially associated with membranous nephropathy (e.g., autoimmune diseases, chronic infections, malignancy).
Previous treatments for membranous nephropathy or related conditions.
History of kidney disease or other relevant medical conditions.
Medications:
List all current medications, including any medications for membranous nephropathy treatment or supportive care.
Social History:
Inquire about tobacco use (may worsen kidney function).
Family history of kidney disease or autoimmune disorders.
Family History:
Presence of kidney disease or autoimmune disorders in first-degree relatives.
Physical Exam:
Vital signs: Assess for elevated blood pressure and signs of fluid overload (edema).
General observation: Look for signs of pale appearance or jaundice (yellowing of skin).
Laboratory Tests:
Urinalysis: May reveal proteinuria and microscopic hematuria.
Urine protein-to-creatinine ratio (UACR): Quantifies proteinuria for diagnosis and monitoring.
Serum creatinine: Assesses kidney function.
Blood count (CBC): May reveal anemia if kidney function is significantly impaired.
Antineutrophil cytoplasmic antibodies (ANCA): To rule out ANCA-associated vasculitis.
Other laboratory tests may be indicated based on specific concerns (e.g., autoimmune workup, antibodies associated with specific causes of membranous nephropathy).
Imaging Studies:
Kidney ultrasound: May reveal abnormalities in kidney size or echogenicity.
Kidney biopsy: The definitive diagnostic test for membranous nephropathy, providing information about thickening of the glomerular basement membrane and potential underlying cause.
Assessment:
Membranous nephropathy: Based on clinical presentation, laboratory findings, and imaging studies (if available), suspect or confirm membranous nephropathy.
Severity of kidney disease: Assess the severity of kidney dysfunction based on urinary protein excretion, serum creatinine, and glomerular filtration rate (GFR) calculated from creatinine.
Potential underlying cause (if identified): Membranous nephropathy can be idiopathic (no known cause) or secondary to other conditions. Identify any underlying causes based on history, physical exam, and laboratory findings (e.g., autoimmune disorders, cancers, infections).
Plan:
Treatment (depends on the severity and underlying cause):
Immunosuppressive medications (e.g., corticosteroids, cyclophosphamide) may be used to suppress the immune system and reduce proteinuria, particularly in cases with rapid decline in kidney function or high-grade proteinuria.
Blood pressure control is crucial to prevent further kidney damage.
Medications to lower proteinuria may be used (e.g., angiotensin-converting enzyme inhibitors or angiotensin receptor blockers).
Treatment of underlying conditions contributing to membranous nephropathy (e.g., infections, autoimmune disorders, malignancies).
Dietary management: May involve protein restriction and sodium restriction to reduce workload on the kidneys.
Monitoring: Schedule regular follow-up visits with laboratory tests (including kidney function tests and urinalysis) and imaging studies (as needed) to monitor disease activity, response to treatment, and kidney function.
Referral to a nephrologist: Consider referral to a nephrologist for specialized care, especially for complex cases, rapidly progressive disease, or those requiring advanced treatment options.
Education:
Educate the patient about membranous nephropathy, symptoms, potential causes, treatment options, and the importance of adherence to medication and dietary recommendations.
Discuss the importance of regular follow-up and potential long-term complications of membranous nephropathy.
Provide resources for kidney disease