Membranoproliferative glomerulonephritis natural history, complications and prognosis

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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
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 the chance of 50% 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.

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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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