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{{Membranoproliferative glomerulonephritis}}
{{Membranoproliferative glomerulonephritis}}
{{CMG}}{{APM}} {{AE}}{{OO}} Nazia Fuad, M.D
{{CMG}}{{APM}} {{AE}}{{OO}} {{N.F}}
==Overview==
==Overview==
There are multiples causes for membranoproliferative glomerulonephritis. Main are [[autoimmune diseases]], mainly [[systemic lupus erythematosus]] (SLE),  [[Sjögren's syndrome|Sjögren syndrome]], [[rheumatoid arthritis]], inherited complement deficiencies (esp C2 deficiency), [[scleroderma]], [[Celiac disease]] .Chronic infections also play major role such as viral infections like [[hepatitis B]], [[hepatitis C]], and [[cryoglobulinemia]] type II, bacterial infections such as [[endocarditis]], infected ventriculoatrial (or jugular) [[Shunt (medical)|shunt]], multiple [[Abscesses|visceral abscesses]], [[leprosy]]. [[Protozoal]] - [[malaria]], [[schistosomiasis]]. Rare causes of MPGN include [[non-Hodgkin lymphoma]], [[renal cell carcinoma]], [[Snake venoms|snake venom]], splenorenal shunt surgery for [[portal hypertension]] , [[melanoma]], [[Alpha 1-antitrypsin deficiency|alpha-1-antitrypsin]] deficiency, and [[Glomerulonephritis|cryoglobulinemic glomerulonephritis]] Idiopathic MPGN is a diagnosis of exclusion.
The most common causes for membranoproliferative glomerulonephritis  [[autoimmune diseases]], mainly [[systemic lupus erythematosus]] (SLE),  [[Sjögren's syndrome|Sjögren syndrome]], [[rheumatoid arthritis]], inherited complement deficiencies (esp C2 deficiency), [[scleroderma]], [[Celiac disease]] .Chronic infections also play major role such as viral infections like [[hepatitis B]], [[hepatitis C]], and [[cryoglobulinemia]] type II, bacterial infections such as [[endocarditis]], infected ventriculoatrial (or jugular) [[Shunt (medical)|shunt]], multiple [[Abscesses|visceral abscesses]], [[leprosy]]. [[Protozoal]] - [[malaria]], [[schistosomiasis]]. Rare causes of MPGN include [[non-Hodgkin lymphoma]], [[renal cell carcinoma]], [[Snake venoms|snake venom]], splenorenal shunt surgery for [[portal hypertension]] , [[melanoma]], [[Alpha 1-antitrypsin deficiency|alpha-1-antitrypsin]] deficiency, and [[Glomerulonephritis|cryoglobulinemic glomerulonephritis]] and Idiopathic MPGN .


==Causes==
==Causes==


Main causes of membranoproliferative pattern of injury are listed as follows:
=== Life- threatening Causes ===
There are no life-threatening causes of membranoproliferative glomerulonephritis. , however complications resulting from untreated membranoproliferative glomerulonephritis  are common.


=== Common Causes ===
Common causes of [[Membranoproliferative glomerulonephritis|MPGN]] may include:<ref>{{Cite journal|last=H. Terence Cook and Matthew C. Pickering|first=|date=2014|title=Histopathology of MPGN and C3 glomerulopathies|url=|journal=NATURE REVIEWS NEPHROLOGY|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=MICHELINE LEVY, MARIE-CLAIRE GUBLER, MIREILLE SICH, AGNES BEZIAU, AND RENE HABIB|first=|date=1978|title=lmmunopathology Glomerulonephritis of Membranoproliferative with Subendothelial Deposits|url=|journal=clinical immunology and immunopathology|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Mårten Segelmark, Thomas Hellmark|first=|date=2010|title=Autoimmune kidney diseases|url=|journal=Elsevier|volume=|pages=|via=}}</ref>
* [[Immune complex]]–mediated disease
* [[Immune complex]]–mediated disease
:*[[Idiopathic]] forms of MPGN or of unknown association<ref>{{Cite journal|last=Fernando C. Fervenza, Sanjeev Sethi, and Richard J. Glassock|first=|date=2012|title=Idiopathic membranoproliferative glomerulonephritis: does it exist?|url=|journal=Nephrology Dialysis Transplantation ( NDT )|volume=|pages=|via=}}</ref>
 
:*:* MPGN type I
:* [[Autoimmune disease]]<nowiki/>s
:*:* MPGN type II or dense deposit disease.
:** [[Systemic lupus erythematosus|Systemic lupus ery]]<nowiki/>[[Systemic lupus erythematosus|thematosus]] (SLE)
:*:* MPGN type III
:** [[Sjögren's syndrome|Sjögren syndrome]]
:* [[Autoimmune disease]]<nowiki/>s<ref>{{Cite journal|last=H. Terence Cook and Matthew C. Pickering|first=|date=2014|title=Histopathology of MPGN and C3 glomerulopathies|url=|journal=NATURE REVIEWS NEPHROLOGY|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=MICHELINE LEVY, MARIE-CLAIRE GUBLER, MIREILLE SICH, AGNES BEZIAU, AND RENE HABIB|first=|date=1978|title=lmmunopathology Glomerulonephritis of Membranoproliferative with Subendothelial Deposits|url=|journal=clinical immunology and immunopathology|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Mårten Segelmark, Thomas Hellmark|first=|date=2010|title=Autoimmune kidney diseases|url=|journal=Elsevier|volume=|pages=|via=}}</ref>
 
:*:* [[Systemic lupus erythematosus]] (SLE)
:** [[Rheumatoid arthritis|Rheumatoid arthrit]]<nowiki/>[[Rheumatoid arthritis|is]]
:*:* [[Sjögren's syndrome|Sjögren syndrome]]
:** [[Scleroderma]]
:*:* [[Rheumatoid arthritis]]
:** [[Celiac disease|Cel]]<nowiki/>[[Celiac disease|iac disease]]
:*:* Inherited complement deficiencies, in particular, C2 deficiency
 
:*:* [[Scleroderma]]
:*:* [[Celiac disease]]
:* Chronic infections
:* Chronic infections
:*:* [[Viral Hepatitis|Viral]] - [[Hepatitis B]], [[hepatitis C]], and [[Cryoglobulinemia|cryoglobulinemia type II]]
:** [[Viral Hepatitis|Viral]] - [[Hepatitis B]], [[hepatitis C]], and [[Cryoglobulinemia|cryoglobulinemia type II]]
:*:* [[Bacterial]] - [[Endocarditis]], infected ventriculoatrial (or jugular) shunt, multiple visceral [[Abscess|abscesses]], [[leprosy]]
:** [[Bacterial]] - [[Endocarditis]], infected ventriculoatrial (or jugular) shunt, multiple visceral [[Abscess|abscesses]], [[leprosy]]
:*:* [[Protozoal]] - [[Malaria]][[Schistosomiasis|, schistosomiasis]]
:** [[Protozoal]] - [[Malaria]][[Schistosomiasis|, schistosomiasis]]
:*:* Other infections - [[Mycoplasma]], [[Lyme disease|Lyme Disease]]<ref>{{Cite journal|last=Dimitrios Kirmizis, MD, Georgios Efstratiadis, MD, Dominiki Economidou, MD, Evdoxia Diza-Mataftsi, MD, Maria Leontsini, MD, and Dimitrios Memmos, MD|first=|date=2004|title=MPGN Secondary to Lyme Disease|url=|journal=American Journal of Kidney Diseases|volume=43|pages=|via=}}</ref>  
:** Other infections - [[Mycoplasma]], [[Lyme disease|Lyme Disease]]<ref>{{Cite journal|last=Dimitrios Kirmizis, MD, Georgios Efstratiadis, MD, Dominiki Economidou, MD, Evdoxia Diza-Mataftsi, MD, Maria Leontsini, MD, and Dimitrios Memmos, MD|first=|date=2004|title=MPGN Secondary to Lyme Disease|url=|journal=American Journal of Kidney Diseases|volume=43|pages=|via=}}</ref>
:* Miscellaneous - [[Chronic liver disease]] ([[cirrhosis]] and [[Alpha 1-antitrypsin deficiency|alpha1-antitrypsin deficiency]])
:* Miscellaneous - [[Chronic liver disease]] ([[cirrhosis]] and [[Alpha 1-antitrypsin deficiency|alpha1-antitrypsin deficiency]])
* Chronic and recovered [[thrombotic microangiopathies]]
* Chronic and recovered [[thrombotic microangiopathies]]
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:* [[Sickle cell anemia]] and [[polycythemia]]
:* [[Sickle cell anemia]] and [[polycythemia]]
:* Transplant [[glomerulopathy]]
:* Transplant [[glomerulopathy]]
* [[Paraprotein]] deposition diseases
:* Glomerulonephropathies associated with [[cryoglobulinemia]] type I
:* Waldenström [[macroglobulinemia]]
:* Immunotactoid glomerulopathy
:* [[Immunoglobulin]] light chain or heavy chain deposition diseases
:* Fibrillary [[glomerulonephritis]]
* [[Malignant]] [[Neoplasm|neoplasms]]
* [[Malignant]] [[Neoplasm|neoplasms]]
:* [[Lymphoma]]
:* [[Lymphoma]]
:* [[Leukemia]]
:* [[Leukemia]]
:* [[Carcinoma]]
:* [[Carcinoma]]
:
=== Less Common Causes ===
Less common causes of MPGN include
* [[Idiopathic]] forms of MPGN or of unknown association<ref>{{Cite journal|last=Fernando C. Fervenza, Sanjeev Sethi, and Richard J. Glassock|first=|date=2012|title=Idiopathic membranoproliferative glomerulonephritis: does it exist?|url=|journal=Nephrology Dialysis Transplantation ( NDT )|volume=|pages=|via=}}</ref>
**MPGN type I
**MPGN type II or dense deposit disease.
**MPGN type III
* [[Paraprotein]] deposition diseases
** Glomerulonephropathies associated with [[cryoglobulinemia]] type I
** Waldenström [[macroglobulinemia]]
** Immunotactoid glomerulopathy
** [[Immunoglobulin]] light chain or heavy chain deposition diseases
** Fibrillary [[glomerulonephritis]]
* Non-Hodgkin lymphoma
* [[Renal cell carcinoma]]
* Snake venom
* Splenorenal shunt surgery for [[portal hypertension]]
* [[Melanoma]]
* [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin deficiency]]
* Inherited complement deficiencies, specially C2 deficiency
=== Genetic Causes ===
* MPGN is caused by a mutation in the complement factor H-related protein 5 (CFHR5)  gene.
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[Endocarditis]], infected ventriculoatrial (or jugular) shunt
|-
| bgcolor="LightSteelBlue" |'''Chemical/Poisoning'''
| bgcolor="Beige" |[[Snake venoms|Snake venom]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Melanoma]], [[Leprosy]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Celiac disease]], hepatitis B and C, chronic liver disease
Splenorenal shunt surgery for portal hypertension
[[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |(CFHR5)  gene mutation, [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |[[Sickle cell anemia]], [[polycythemia]] and non-hodgkin lymphoma,
[[cryoglobulinemia]],
[[Lymphoma]]
[[Leukemia]]
[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Viral hepatitis|Viral]] - [[hepatitis B]], [[hepatitis C]], and [[Cryoglobulinemia|cryoglobulinemia type II]]
[[Bacterial]] - [[endocarditis]], infected ventriculoatrial (or jugular) shunt, multiple visceral [[Abscess|abscesses]], [[leprosy]]
[[Protozoal]] - [[malaria]][[schistosomiasis|, schistosomiasis]]
Other infections - [[mycoplasma]], [[lyme disease|lyme Disease]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |[[Leprosy]]
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional/Metabolic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |[[Lymphoma]], [[leukemia]], [[carcinoma]]
|-
|- bgcolor="LightSteelBlue"
|'''Ophthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose/Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Mycoplasma pneumonia]], [[Alpha 1-antitrypsin deficiency|alpha-1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal/Electrolyte'''
| bgcolor="Beige" |Rnal cell carcinoma
[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
[[Radiation]] [[nephritis]]
[[Nephropathy]] associated with [[bone marrow transplantation]]
Transplant [[glomerulopathy]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" |[[Systemic lupus erythematosus|Systemic lupus ery]]<nowiki/>[[Systemic lupus erythematosus|thematosus]] (SLE)
[[Sjögren's syndrome|Sjögren syndrome]]
<nowiki/>[[Rheumatoid arthritis|Rheumatoid arthrit]]<nowiki/>[[Rheumatoid arthritis|is]]
[[Scleroderma]]
[[Celiac disease|Celia]][[Celiac disease|c disease]]
[[Immunoglobulin]] light chain or heavy chain deposition diseases
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |[[Chronic liver disease]] ([[cirrhosis]] and [[Alpha 1-antitrypsin deficiency|alpha1-antitrypsin deficiency]])
|-
|}


==References==
==References==

Latest revision as of 01:08, 3 August 2018

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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] Nazia Fuad M.D.

Overview

The most common causes for membranoproliferative glomerulonephritis autoimmune diseases, mainly systemic lupus erythematosus (SLE), Sjögren syndrome, rheumatoid arthritis, inherited complement deficiencies (esp C2 deficiency), scleroderma, Celiac disease .Chronic infections also play major role such as viral infections like hepatitis B, hepatitis C, and cryoglobulinemia type II, bacterial infections such as endocarditis, infected ventriculoatrial (or jugular) shunt, multiple visceral abscesses, leprosy. Protozoal - malaria, schistosomiasis. Rare causes of MPGN include non-Hodgkin lymphoma, renal cell carcinoma, snake venom, splenorenal shunt surgery for portal hypertension , melanoma, alpha-1-antitrypsin deficiency, and cryoglobulinemic glomerulonephritis and Idiopathic MPGN .

Causes

Life- threatening Causes

There are no life-threatening causes of membranoproliferative glomerulonephritis. , however complications resulting from untreated membranoproliferative glomerulonephritis are common.

Common Causes

Common causes of MPGN may include:[1][2][3]

Less Common Causes

Less common causes of MPGN include

    • MPGN type I
    • MPGN type II or dense deposit disease.
    • MPGN type III
  • Paraprotein deposition diseases

Genetic Causes

  • MPGN is caused by a mutation in the complement factor H-related protein 5 (CFHR5) gene.

Causes by Organ System

Cardiovascular Endocarditis, infected ventriculoatrial (or jugular) shunt
Chemical/Poisoning Snake venom
Dental No underlying causes
Dermatologic Melanoma, Leprosy
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Celiac disease, hepatitis B and C, chronic liver disease

Splenorenal shunt surgery for portal hypertension

Alpha-1-antitrypsin deficiency

Genetic (CFHR5) gene mutation, Alpha-1-antitrypsin deficiency
Hematologic Sickle cell anemia, polycythemia and non-hodgkin lymphoma,

cryoglobulinemia,

Lymphoma

Leukemia

Hemolytic uremic syndrome

Iatrogenic No underlying causes
Infectious Disease Viral - hepatitis B, hepatitis C, and cryoglobulinemia type II

Bacterial - endocarditis, infected ventriculoatrial (or jugular) shunt, multiple visceral abscesses, leprosy

Protozoal - malaria, schistosomiasis

Other infections - mycoplasma, lyme Disease

Musculoskeletal/Orthopedic No underlying causes
Neurologic Leprosy
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Lymphoma, leukemia, carcinoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Mycoplasma pneumonia, alpha-1-antitrypsin deficiency
Renal/Electrolyte Rnal cell carcinoma

Hemolytic uremic syndrome

Radiation nephritis

Nephropathy associated with bone marrow transplantation

Transplant glomerulopathy

Rheumatology/Immunology/Allergy Systemic lupus erythematosus (SLE)

Sjögren syndrome

Rheumatoid arthritis

Scleroderma

Celiac disease

Immunoglobulin light chain or heavy chain deposition diseases

Sexual No underlying causes
Trauma No underlying causes
Urologic Hemolytic uremic syndrome
Miscellaneous Chronic liver disease (cirrhosis and alpha1-antitrypsin deficiency)

References

  1. ↑ H. Terence Cook and Matthew C. Pickering (2014). "Histopathology of MPGN and C3 glomerulopathies". NATURE REVIEWS NEPHROLOGY.
  2. ↑ MICHELINE LEVY, MARIE-CLAIRE GUBLER, MIREILLE SICH, AGNES BEZIAU, AND RENE HABIB (1978). "lmmunopathology Glomerulonephritis of Membranoproliferative with Subendothelial Deposits". clinical immunology and immunopathology.
  3. ↑ Mårten Segelmark, Thomas Hellmark (2010). "Autoimmune kidney diseases". Elsevier.
  4. ↑ Dimitrios Kirmizis, MD, Georgios Efstratiadis, MD, Dominiki Economidou, MD, Evdoxia Diza-Mataftsi, MD, Maria Leontsini, MD, and Dimitrios Memmos, MD (2004). "MPGN Secondary to Lyme Disease". American Journal of Kidney Diseases. 43.
  5. ↑ Fernando C. Fervenza, Sanjeev Sethi, and Richard J. Glassock (2012). "Idiopathic membranoproliferative glomerulonephritis: does it exist?". Nephrology Dialysis Transplantation ( NDT ).

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