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## Meet the editor

Thomas Rath is a doctor of medicine and specialist in internal medicine, nephrology, hypertension, and infectious diseases. He lives in Kaiserslautern, a city of 100,000 inhabitants in the southwest part of Germany. After completing his studies at the University of Mainz, he became a resident at the Westpfalz-Klinikum in Kaiserslautern, a tertiary care hospital with 1300 hospital beds. There, he is Head of the Department of

Nephrology and Transplantation Medicine and also responsible for the outpatient clinic for patients with infectious diseases. He is an active member of many national and international societies. During his scientific career he has published more than 25 papers in peer-reviewed journals and more than 150 abstracts and posters at national and international congresses. He gives lectures at the Technical University of Kaiserslautern on "artificial organ support."

Contents

**Section 1**

**Section 2**

**Section 3**

*by Barbara Katharina Geist*

*by Samuel N. Uwaezuoke*

Membranous Nephropathy

*and César Luis Ramírez-Tortosa*

*and David Johnson*

Biomarkers in Renal Vasculitis

*by Polyvios Arseniou, Stamatia Stai and Maria Stangou*

Childhood Idiopathic Nephrotic Syndrome as a Podocytopathy

*by Bhadran Bose, Sunil V. Badve, Vivekanand Jha, Chen Au Peh* 

*by Patrick Hamilton, Durga Kanigicherla and Paul Brenchley*

Treatment of Idiopathic Membranous Nephropathy (IMN) *by María Carmen Prados Soler, María Dolores Del Pino y Pino,* 

**Preface III**

Measuring Kidney Function **1**

**Chapter 1 3**

**Chapter 2 13**

Glomerulonephritis in Childhood **33**

**Chapter 3 35**

Membranous Nephropathy **47**

**Chapter 4 49**

**Chapter 5 71**

**Chapter 6 89**

Primary Membranous Nephropathy as a Model of Autoimmune Disease

*Álvaro Pérez Fernández, Llenalia Gordillo García, María José López Ruiz* 

Calculation of GFR via the Slope-Intercept Method in Nuclear Medicine

## Contents


#### **Section 4** Renal Rehabilitation **101**

**Chapter 7 103** Renal Rehabilitation: A Perspective From Human Body Movement *by Jorge Enrique Moreno Collazos and Diana Carolina Zona Rubio*

Preface

Chronic kidney disease (CKD) is a worldwide disease affecting up to 4% of the population with increasing figures also in developing countries. Life expectancy of patients affected by CKD is shortened compared to the overall population and only a minority of the patients reaches end-stage renal disease with the need for dialysis or renal transplantation; death overtakes dialysis. In many cases, glomerulonephritis is the underlying disease leading to kidney failure. One hallmark of glomerulonephritis is proteinuria, which may in its most severe form lead to nephrotic syndrome. Clinically, the syndrome presents with massive proteinuria, hypoalbuminuria, edema, and hyperlipidemia. In children, idiopathic nephrotic syndrome is the commonest manifestation of glomerular disease. Although the genetics of congenital forms are well known to the pediatrician, secondary forms of nephrotic syndrome caused by different types of glomerulonephritis are encountered. The etiopathogenesis of nephrotic syndrome has evolved over several years and theories. Now, podocyte injury is thought to be the keystone in the pathology of different forms of glomerulonephritis associated with massive proteinuria. Therefore, one chapter aims to highlight the mechanisms underlying the pathogenesis of nephrotic

But also in adults, nephrotic syndrome caused by different types of glomerulonephritis occurs. One form of glomerulonephritis of special interest is membranous nephropathy. In non-diabetic Caucasian adults, membranous nephropathy is the leading cause of nephrotic syndrome. There, membranous nephropathy is most often primary (idiopathic) and the remaining is secondary to systemic disease or exposure to infection or drugs. The therapeutic approach reaches from supportive care to immunosuppressive protocols, always trying to minimize proteinuria.

Three chapters of this book focus on membranous nephropathy. There is a fine and concise review of the epidemiology, diagnosis, and treatment of membranous nephropathy, particularly focusing on idiopathic membranous nephropathy. Another chapter strengthens the aspect of membranous nephropathy as an autoimmune disease, aiming to increase our current understanding of autoimmune membranous nephropathy and use it as a basis for the understanding of autoim-

One important clinical aspect in patients with nephrotic syndrome, especially in membranous nephropathy, is increased risk for venous thrombosis. Hypercoagulopathy as a result of the loss of antithrombotic factors such as antithrombin III and plasminogen due to proteinuria, an increased level of factor VIII and fibrinogen, along with increased platelet reactivity have been noted in nephrotic syndrome whatever the cause. However, compared to other conditions that have a similar degree of proteinuria, membranous nephropathy has a higher

Interestingly, many patients with membranous nephropathy have circulating antibodies to different podocyte antigens, and immunologic remission (depletion of PLA2R antibodies) often precedes and may predict clinical remission. The use

syndrome as a podocytopathy, especially in children.

risk of venous thrombosis and its associated risks.

mune disease in general.
