Membranoproliferative glomerulonephritis (patient information)

Overview

Membranoproliferative glomerulonephritis ( MPGN ), also known as mesangiocapillary glomerulonephritis, is a type of  glomerulonephritis and an uncommon cause of chronic nephritis caused by dense deposits in the kidney glomerular mesangium. It can be subdivided into secondary and idiopathic forms, which can distinguished by clinical features, laboratory data and renal histopathology. Membranoproliferative glomerulonephritis is a type of  glomerulonephritis (GN), which can happen due to malfunction of immune system. Each individual immune system is responsible for fight against infections or other kind of disease to maintain health, inversely in autoimmune disorders such as MPGN, immune system starts to attack healthy cell same as what happen in MPGN and eventuate in destruction of kidney glomeruli.

What is the symptoms of Membranoproliferative glomerulonephritis?

The signs and symptoms of MPGN vary based on each individual and the type of MPGN occurred. It can be different from no symptoms to really obvious symptoms. These symptoms can included:

• Edema or swelling in feet, hands or face
  • Due to loss of protein in urine

• Turbid (cloudy) urine

• Blood in the urine (hematuria)
  • Maybe it can not be seen with naked eye
• Changes in mental status
• Decrease in urine volume

What causes Membranoproliferative glomerulonephritis?

MPGN occurs mostly as a complication of other disease originated out of kidney for instance, due to immune system malfunction. Immune system malfunction causes the immune system cells to attack healthy cells. There are some conditions which contribute to the abnormal immune system function such as:

• Autoimmune disease, such as:
  • Lupus erythematosus
  • sarcoidosis
  • Sjogren’s syndrome
  • Cryoglobulinemia
  • Monoclonal immunoglobulin deposition diseases (that included, light and heavy chain deposition disease and AL amyloidosis)
• Infectious disease, such as
  • Hepatitis B
  • Hepatitis C
  • Malaria
  • Subacute bacterial endocarditis
  • Infection of a ventriculoatrial shunt

• Hematologic cancers, such as
  • Lymphoma
  • Leukemia

Who is at higher risk?

As mentioned above there is a correlation between autoimmune disease and Membranoproliferative glomerulonephritis, so if an individual have any kind of autoimmune disease there is a little increase risk to acquired MPGN. Some infectious disease such as Hepatitis B,C and Malaria potentially can increase the risk of MPGN.

When to seek urgent medical care?

Each individual should seek medical care when such symptoms and signs have been seen:

• Edema of hands and feet
• Blood in the urine
• Decrease in urine volume

Diagnosis

diagnosis of MPGN based on the presence of the initial symptoms and signs of disease. The first step of diagnosis is blood and urine simple tests, and if the patient have such more serious signs like edema or high blood pressure, further laboratory tests have been ordered which included:

• urinalysis 
• urine protein test (24 hr )
• blood urea nitrogen (BUN) and creatinine level tests
• serum complement C3 level test

As the definite diagnosis of MPGN confirmed by kidney biopsy, if the result of these laboratory test suggest MPGN, kidney biopsy is necessary to confirm the diagnosis and the initiation of treatment.

Treatment options

The severity of disease determine the stage of the treatment; since there is not any definite cure for this disease, all of the treatment options developed to reduce the progression of the disease. Due to new medications, some individuals have not shown any progression in their symptoms and signs, in some cases has been seen the slowing of progression of the disease though it has been reported that all of the treatment options are useless in a few percentage of the patient and their condition eventuated in renal failure and they will need life time dialysis or kidney transplant.

Prevention of Membranoproliferative glomerulonephritis

Since the etiology of MPGN is not clearly confirmed, so there is not any definite prevention for this disease.

What to expect (outlook/prognosis)?

The prognosis of MPGN is depend on the severity of patient condition and her/his response to the medications, in one hand some individuals condition terminated in renal failure and will be needed life time dialysis or kidney transplant, in the other hand some cases condition regress and they will not need further treatment.

possible complications

One of the most common complication of MPGN is acute or chronic nephritis which are some sort of non specific symptoms and signs that include:

• Blood in the urine
• Decrease the volume of urine
• Joint pain
• Shortness of the breath
• Cough
• Edema
• Changes in mental status
• Tremor
• Blurred vision