Membranoproliferative glomerulonephritis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief:

Overview

The natural history of membranoproliferative glomerulonephritis (MPGN) is characterised by severity of clinical features which fluctuate often. Complete remission is seen in few cases only. Acute presentation and a slower reduction in renal function have seen more in children than adults. End stage renal disease is seen in approximately 40% of patients within 10 years of diagnosis. Features suggestive of an adverse outcome include nephrotic syndrome, renal dysfunction at onset, and persistent hypertension. Type II MPGN is associated with a worse prognosis. Recurrence occurs in 20 - 30% of type I and 80 - 90 % type II MPGN. The most common complications in patients who have MPGN are end-stage renal disease ESRD, edema, hypertension, infection with encapsulated bacteria hemophilus, Streptococcus, and Klebsiella species, thromboembolism and hyperlipidemia. Factors associated with poor prognosis of MPGN include Hypertension, elderly individuals and low GFR at 1st year of presentation.

Natural history

The natural history of membranoproliferative glomerulonephritis (MPGN) is characterised by severity of clinical features which autonomously fluctuate, with very few cases of complete remission. Acute presentation and a slower reduction in renal function have seen more in children than adults. ESRD have been occurred among approximately 40% of patients within 10 years of diagnosis. Features suggestive of an adverse outcome include the nephrotic syndrome, renal dysfunction at onset, and persistent hypertension. Type II MPGN is associated with a worse prognosis, as is the presence of chronic interstitial damage on renal biopsy. In 20 - 30% of type I and 80 - 90 % type II MPGN, membranoproliferative glomerulonephritis may recur.

Complication

Common complications of MPGN include:

End-stage renal disease (ESRD)
Edema
- Periorbital
- Dependent edema
Infection with encapsulated bacteria
- Haemophilus species
- Streptococcus species
- Klebsiella species
Thromboembolism events
- There are several predisposing factor that can increase thromboembolism tendency, these factors are:
  - Decrease in anticoagulant factors such as, proteins C and S and antithrombin III
  - Increased platelet aggregability
  - Increase procoagulants proteins
  - Hyperlipidemia
  - Impaired fibrinolysis
Malnutrition
Anemia due to iron deficiency
Hypocalcemia due to hyperparathyroidism secondary to vitamin D deficiency

Prognosis

Patients with MPGN type 1 and nephrotic syndrome have 50% vulnerability to develop end-stage renal disease (ESRD) within 10 years and 90% in 20 years. Type II MPGN is some how more aggressive and 50% of patients eventuate in ESRD after 10 years of diagnosis. Factors that are associated with poor prognosis of MPGN include:^[1]^[2]^[3]

Hypertension at presentation
Elderly individuals
Low GFR at 1st year of presentation

References

↑ Janette C.Cansick, Rachel lennon (2004). "prognosis, treatment and outcome of childhood mesangiocapillary". Nephrology Dialysis Transplantation.
↑ Michelle M. O’Shaughnessy, Maria E. Montez-Rath, Richard A. Lafayette and Wolfgang C. Winkelmayer (2015). "Differences in initial treatment modality for end-stage renal disease among glomerulonephritis subtypes in the USA". Nephrology Dialysis Transplantation.
↑ Sanjeev Sethi, M.D., Ph.D., and Fernando C. Fervenza, M.D., Ph.D. (2012). "Membranoproliferative Glomerulonephritis — A New Look at an Old Entity". The new england journal of medicine.

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[1] Janette C.Cansick, Rachel lennon (2004). "prognosis, treatment and outcome of childhood mesangiocapillary". Nephrology Dialysis Transplantation.

[2] Michelle M. O’Shaughnessy, Maria E. Montez-Rath, Richard A. Lafayette and Wolfgang C. Winkelmayer (2015). "Differences in initial treatment modality for end-stage renal disease among glomerulonephritis subtypes in the USA". Nephrology Dialysis Transplantation.

[3] Sanjeev Sethi, M.D., Ph.D., and Fernando C. Fervenza, M.D., Ph.D. (2012). "Membranoproliferative Glomerulonephritis — A New Look at an Old Entity". The new england journal of medicine.

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