Membranoproliferative glomerulonephritis natural history, complications and prognosis: Difference between revisions
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== Natural history == | == 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. | 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 == | == Complication == | ||
the most common complications in patients who have MPGN are included: | the most common complications in patients who have MPGN are included: | ||
* End-stage renal disease (ESRD) | * [[End-stage renal disease]] (ESRD) | ||
* Edema | * [[Edema]] | ||
** Periorbital | ** [[Periorbital]] | ||
** Dependent edema | ** Dependent [[edema]] | ||
* Hypertension | * [[Hypertension]] | ||
* Infection with encapsulated bacteria | * Infection with [[encapsulated bacteria]] | ||
** ''Haemophilus'' species | ** ''[[Haemophilus]]'' species | ||
** ''Streptococcus'' species | ** ''[[Streptococcus]]'' species | ||
** ''Klebsiella species'' | ** ''[[Klebsiella]] species'' | ||
* Thromboembolism events | * [[Thromboembolism]] events | ||
** There are several predisposing factor that can increase thromboembolism tendency, these factors are: | ** 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 | *** Decrease in [[anticoagulant]] factors such as, [[proteins C and S]] and [[antithrombin]] III | ||
*** Increased platelet aggregability | *** Increased [[platelet]] aggregability | ||
*** Increase procoagulants proteins | *** Increase [[procoagulants]] proteins | ||
*** Hyperlipidemia | *** [[Hyperlipidemia]] | ||
*** Impaired fibrinolysis | *** Impaired [[fibrinolysis]] | ||
* Hyperlipidemia | * [[Hyperlipidemia]] | ||
* Malnutrition | * [[Malnutrition]] | ||
* Anemia due to iron deficiency | * [[Anemia]] due to iron deficiency | ||
* Hypocalcemia due to hyperparathyroidism secondary to vitamin D deficiency | * [[Hypocalcemia]] due to [[hyperparathyroidism]] secondary to [[vitamin D]] deficiency | ||
== Prognosis == | == Prognosis == | ||
Factors that worsen the prognosis of MPGN are:<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> | Factors that worsen the [[prognosis]] of MPGN are:<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> | ||
* Hypertension at presentation | * [[Hypertension]] at presentation | ||
* Elderly individuals | * Elderly individuals | ||
* Low GFR at 1st year of presentation | * Low [[GFR]] at 1st year of presentation | ||
Patients with MPGN type 1 and nephrotic syndrome have | 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.<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> | ||
==References== | ==References== | ||
Revision as of 19:39, 25 July 2018
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Overview
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
the most common complications in patients who have MPGN are included:
- End-stage renal disease (ESRD)
- Edema
- Periorbital
- Dependent edema
- Hypertension
- 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:
- Hyperlipidemia
- Malnutrition
- Anemia due to iron deficiency
- Hypocalcemia due to hyperparathyroidism secondary to vitamin D deficiency
Prognosis
Factors that worsen the prognosis of MPGN are:[1]
- Hypertension at presentation
- Elderly individuals
- Low GFR at 1st year of presentation
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.[2][3]
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.