India is a developing country with a large patient population suffering from end stage kidney disease (ESKD) (1). The need for kidney replacement therapy in the form of dialysis ranges from being a planned procedure to an emergency requiring immediate initiation. Optimal dialysis access planning should ideally begin in the predialysis stage. The planning depends upon the co-morbidities, patient preferences, local anatomy, demographics (age and sex), and availability of an interventional nephrologist or radiologist. The goal of dialysis access planning is to obtain successful immediate and long-term dialysis access with the least number of complications. Indeed, where there
Membranous nephropathy (MN) is a common cause of adult nephrotic syndrome, which may present as a sub-nephrotic or nephrotic range proteinuria with hypoalbuminemia, hyperlipidemia, and edema. It is an immune-mediated glomerular disease that is pathologically characterized by glomerular intra-membranous and sub-epithelial immune complex deposits (immunoglobulin G4 [IgG4] and complement 3 [C3]) causing membrane thickening.
The pathophysiology of MN was first described by the Heymann nephritis rat model in 1959 (1). Although the target antigen described in that model was “megalin,” which does not play a major role in humans, it set the path for subsequent discoveries of many