Membranoproliferative glomerulonephritis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3]
Treatment of MPGN There are three components to the treatment of membranoproliferative glomerulonephritis (MPGN):
- Treatment of the underlying cause of the MPGN, (eg, infection);
- assessment of the factors that predict renal prognosis; and
- Treatment of the MPGN, mostly with immunosuppressive drugs.
Treatment of the underlying cause of the MPGN MPGN due chronic infections should be treated with antivirals, antimicrobials and antiparasitic drugs with drug choice based on the kind of infection. Immunosuppressive therapy is not indicated and may be harmful in cases with MPGN caused by hepatitis B or C [1].
MPGN due to an autoimmune disease should be treated for the autoimmune disorder. On the contrary, it is essential to treat successfully hepatitis with antiviral agents. Cryoglobulinemic MPGN should also be treated with antiviral therapy, if associated with HCV infection.
Rituximab has been also used in cases with MPGN associated with a monoclonal gammopathy and it gave a long-lasting complete or partial remissions in 7/8 cases[2]. Also, rituximab has been shown effective in the treatment of MPGN associated with chronic lymphocytic leukemia [3].
With all the above treatment, Glomerular filtration Rate should be carefully monitored as a tool to check response to therapy.
Assessment of the factors that predict renal prognosis Good prognosis is associated with non-nephrotic proteinuria (less than 3.5 g/day, no hypoalbuminemia, and no edema), normal serum creatinine/GFR, and normal blood pressure. Poor prognostic signs at presentation include evidence of nephrotic syndrome, elevated serum creatinine, hypertension plus hematuria. Bad prognosis is also associated with Idiopathic MPGN and signs of tubulointerstitial disease (interstitial inflammation, fibrosis, and tubular atrophy) which correspond to great glomerular damage.
Treatment of the MPGN, mostly with immunosuppressive drugs Indications for immunosuppressive therapy include:
- nephrotic range proteinuria, a
- reduced estimated glomerular filtration,
- and/or severe histologic changes on renal biopsy (eg, crescents)
References
- ↑ Sandri AM, Elewa U, Poterucha JJ, Fervenza FC (2011). "Treatment of hepatitis C-mediated glomerular disease". Nephron Clin Pract. 119 (2): c121–9, discussion c129-30. doi:10.1159/000325220. PMID 21757949.
- ↑ Guiard E, Karras A, Plaisier E, Duong Van Huyen JP, Fakhouri F, Rougier JP; et al. (2011). "Patterns of noncryoglobulinemic glomerulonephritis with monoclonal Ig deposits: correlation with IgG subclass and response to rituximab". Clin J Am Soc Nephrol. 6 (7): 1609–16. doi:10.2215/CJN.10611110. PMID 21700823.
- ↑ Bartel C, Obermüller N, Rummel MJ, Geiger H, Hauser IA (2008). "Remission of a B cell CLL-associated membranoproliferative glomerulonephritis Type I with rituximab and bendamustine". Clin Nephrol. 69 (4): 285–9. PMID 18397703.