Membranous Nephropathy

An adult with heavy proteinuria, a low serum albumin level, edema, and hyperlipidemia has a nephrotic pattern. Membranous nephropathy is one possible cause; edema alone does not establish the diagnosis. The clinical task is to distinguish primary autoimmune disease from secondary membranous nephropathy, then judge kidney-function trajectory and nephrotic complications before immunosuppression is considered. That sequence protects the patient. Secondary disease may improve when its trigger is treated, whereas immunosuppression can worsen infection and complicate malignancy evaluation. The RN's highest-yield trends are weight and edema, urine protein, albumin, creatinine/eGFR, blood pressure, and symptoms suggesting thrombosis or infection. A preserved creatinine does not make severe hypoalbuminemia benign.