Risk stratification of patients with primary membranous nephropathy*

	Risk of progression
	Low	Moderate	High	Very high
	Over an observation period of 3 to 6 months^¶, at least 2 of 3 criteria must be present:			2 or more of the following at the time of diagnosis:
Kidney function	Normal or stable (<25% decrease) eGFR over the observation period	Normal or stable (<25% decrease) eGFR over the observation period	Decrease in eGFR ≥25%, not explained by other causes, at any time during the observation period	Serum creatinine ≥1.5 mg/dL (≥133 micromol/L), considered due to active MN Decrease in eGFR ≥25% from baseline over the prior 2 years, considered due to active MN Severe, disabling, or life-threatening nephrotic syndrome^◊
Proteinuria	<4 g/day at the end of the observation period	Between 4 and 8 g/day at the end of the observation period	>8 g/day at the end of the observation period or Persistent nephrotic syndrome^Δ
Serum anti-PLA2R antibody levels (only in patients with anti-PLA2R antibody-positive MN)	Serial titers are persistently low (arbitrarily defined as <50 RU/mL by ELISA) or are decreasing ≥25% by over the observation period	Serial titers are <150 RU/mL and stable or increasing by <25%	Serial titers are high (arbitrarily defined as ≥150 RU/mL by ELISA) and not declining or are increasing to ≥150 RU/mL

eGFR: estimated glomerular filtration rate; MN: membranous nephropathy; PLA2R: phospholipase A2 receptor; ELISA: enzyme-linked immunosorbent assay.
* Risk stratification of patients with primary MN is used to guide decisions about initial therapy. Refer to relevant UpToDate content on the choice of initial therapy based upon risk. This risk stratification algorithm applies only to the likelihood of progressive kidney failure. It does not take into account the risks that may be associated with other complications of the nephrotic syndrome, such as worsening atherosclerosis due to hyperlipidemia and thromboemboli due to the associated hypercoagulable state.
¶ In patients who are not at very high risk, risk stratification is determined after an initial observation period of 3 to 6 months during which the patient receives general supportive measures (including renin-angiotensin system inhibition), and clinical (24-hour urine protein excretion, serum creatinine, serum albumin) and serologic parameters (serum anti-PLA2R antibody levels in patients with PLA2R-associated MN) are measured at baseline and monitored every 1 to 3 months.
Δ Nephrotic syndrome is defined by the presence of proteinuria >3.5 g/day and serum albumin <3.5 g/dL (if measured by bromocresol green methods) or <3.0 g/dL (if measured by bromocresol purple methods).
◊ Severe, disabling, or life-threatening nephrotic syndrome is defined by a serum albumin <2.5 g/dL (if measured by bromocresol green methods) or <2.0 g/dL (if measured by bromocresol purple methods) and refractory edema, or a thromboembolic event.

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Risk stratification of patients with primary membranous nephropathy*