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]

There are three factors to consider the treatment of membranoproliferative glomerulonephritis (MPGN):

• Identify the underlying cause of the MPGN, (e.g. lupus, infection, disorders of the complement pathway, or ideopathic MPGN);
• Asses the factors that predict renal prognosis (e.g. degree of proteinuria, age, comorbidities); and
• Treat the underlying cause of the MPGN,

Treatment of the underlying cause of the MPGN

Once the underlying cause of the MPGN is identified, therapy should be targeted accordingly.

MPGN due infections should target the causative pathogen. This can include antivirals, antimicrobials and antiparasitic drugs. Immunosuppressive therapy is contraindicated and can be harmful in cases of hepatitis B or C mediated MPGN.

See therapy for: Hepatitis B, Hepatitis C,.....

MPGN due to an autoimmune disease should target the primary disorder and should take into consideration patients age, severity of kidney involvement, and other organ involvements.

See therapy for lupus nephritis, ideopathic cryglobulinemia, paraprotein related kidney disease, C3 glomerulonephritis....

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. Also, rituximab has been shown effective in the treatment of MPGN associated with chronic lymphocytic leukemia .

Ideopathic MPGN: Indications for immunosuppressive therapy include:

• nephrotic range proteinuria, a
• reduced estimated glomerular filtration,
• and/or severe histologic changes on renal biopsy (eg, crescents)

Treatment of ideopathic MPGN includes (xxx)

with immunosuppressive drugs

With all the above treatment, Blood pressure, eGFR, proteinuria, and hematuria should be carefully monitored as a tool to check response to therapy. Follow up biopsy may be done in select case to evaluate for response, prognosis, and transformation of disease (e.g change in lupus nephritis class)

Assessment of the factors that predict renal prognosis:

In general, non-nephrotic range proteinuria (less than 3.5 g/day) and lack of nephrotic syndrome (no hypoalbuminemia, no hyperlipidemia), normal serum creatinine/GFR, and normal blood pressure are all associated with a better prognosis. Poor prognostic signs at presentation include evidence of nephrotic and nephritic syndrome, including 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.