Membranoproliferative glomerulonephritis natural history, complications and prognosis: Difference between revisions
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__NOTOC__{{Membranoproliferative glomerulonephritis}} | __NOTOC__ | ||
{{Membranoproliferative glomerulonephritis}} | |||
{{CMG}} ; {{AE}} | |||
== Overview == | == 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 | 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]] ''[[Haemophilus|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 == | == Natural history == | ||
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== Complication == | == Complication == | ||
Common complications of MPGN include: | |||
* [[End-stage renal disease]] (ESRD) | * [[End-stage renal disease]] (ESRD) | ||
* [[Edema]] | * [[Edema]] | ||
** [[Periorbital]] | ** [[Periorbital]] | ||
** Dependent [[edema]] | ** Dependent [[edema]] | ||
* Infection with [[encapsulated bacteria]] | * Infection with [[encapsulated bacteria]] | ||
** ''[[Haemophilus]]'' species | ** ''[[Haemophilus]]'' species | ||
| Line 26: | Line 26: | ||
*** [[Hyperlipidemia]] | *** [[Hyperlipidemia]] | ||
*** Impaired [[fibrinolysis]] | *** Impaired [[fibrinolysis]] | ||
* [[Malnutrition]] | * [[Malnutrition]] | ||
* [[Anemia]] due to iron deficiency | * [[Anemia]] due to iron deficiency | ||
| Line 32: | Line 31: | ||
== Prognosis == | == Prognosis == | ||
Factors that | 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:<ref>{{Cite journal|last=Janette C.Cansick, Rachel lennon|first=|date=2004|title=prognosis, treatment and outcome of childhood mesangiocapillary|url=|journal=Nephrology Dialysis Transplantation|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Michelle M. O’Shaughnessy, Maria E. Montez-Rath, Richard A. Lafayette and Wolfgang C. Winkelmayer|first=|date=2015|title=Differences in initial treatment modality for end-stage renal disease among glomerulonephritis subtypes in the USA|url=|journal=Nephrology Dialysis Transplantation|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Sanjeev Sethi, M.D., Ph.D., and Fernando C. Fervenza, M.D., Ph.D.|first=|date=2012|title=Membranoproliferative Glomerulonephritis — A New Look at an Old Entity|url=|journal=The new england journal of medicine|volume=|pages=|via=}}</ref> | ||
* [[Hypertension]] at presentation | * [[Hypertension]] at presentation | ||
* Elderly individuals | * Elderly individuals | ||
* Low [[GFR]] at 1st year of presentation | * Low [[GFR]] at 1st year of presentation | ||
==References== | ==References== | ||
Latest revision as of 20:16, 6 August 2018
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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
- There are several predisposing factor that can increase thromboembolism tendency, these factors are:
- 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.