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SHR Neuro Cancer Cardio Lipid Metab Microb

Rudnicki, M; Windpessl, M; Eller, K; Odler, B; Gauckler, P; Neumann, I; Zitt, E; Regele, H; Kronbichler, A; Lhotta, K; Säemann, MD.
[Diagnosis and treatment of glomerular diseases with a membranoproliferative glomerulonephritis (MPGN) pattern of injury].
Wien Klin Wochenschr. 2023; 135(Suppl 5): 688-695. Doi: 10.1007/s00508-023-02264-7 [OPEN ACCESS]
Web of Science PubMed FullText FullText_MUG

 

Co-authors Med Uni Graz

Eller Kathrin

Odler Balazs

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Abstract:

Membranoproliferative glomerulonephritis (MPGN) represents a heterogeneous group of diseases. The common feature of a membranoproliferative lesion pattern in the kidney biopsy can either be idiopathic/primary or-much more frequently-have a secondary cause. The historical classification into MPGN types I to III has largely been abandoned and replaced in recent years by a pathogenesis-oriented classification. A MPGN with C1q, C3 and/or C4 deposits on light microscopy is referred to as immune complex GN (IC-GN), while a MPGN with dominant C3 deposits is referred to as C3 glomerulopathy (C3G). C3G is further divided into C3 glomerulonephritis (C3GN) and dense deposit disease (DDD). These diagnoses can only be made by a kidney biopsy. Possible causes of MPGN are chronic infections (especially hepatitis B and C, bacterial infections, infections with protozoa), autoimmune diseases (especially lupus, rheumatoid arthritis) or malignancies (especially hematological malignancies). Particularly in the case of C3G a comprehensive analysis of the complement system components is strongly recommended. Due to the low incidence and the heterogeneous clinical appearance of MPGN therapeutic decisions must be made individually; an optimal general therapy is unknown, except that supportive treatment as with other glomerular diseases should be optimized. In the case of a secondary MPGN it is generally recommended to treat the potential cause of the MPGN. If significant proteinuria persists and eGFR remains > 30 ml/min/1.73 m², treatment with systemic steroids and mycophenolate mofetil is recommended. Other treatment options on an individual level after evaluation and discussion of the risk-benefit ratio with the patient are rituximab and eculizumab. Rapidly progressive MPGN should be treated like ANCA-associated vasculitis. The recurrence rates after kidney transplantation are very high and treatment is challenging.

Find related publications in this database (using NLM MeSH Indexing)

Humans - administration & dosage

Glomerulonephritis, Membranoproliferative - diagnosis, therapy

Kidney Transplantation - administration & dosage

Arthritis, Rheumatoid - administration & dosage

Autoimmune Diseases - administration & dosage

Mycophenolic Acid - administration & dosage

Find related publications in this database (Keywords)

Immune-complex glomerulonephrits

C3 glomerulonephritis

Dense deposit disease

Supportive treatment

Rituximab

Eculizumab

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