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Membranoproliferative GN
Definition
Membranoproliferative glomerulonephritis is a kidney disorder that involves inflammation and changes to kidney cells. It may lead to kidney problems.
Alternative Names
Membranoproliferative GN I; Membranoproliferative GN II; Mesangiocapillary glomerulonephritis; Membranoproliferative glomerulonephritis; Lobular GN; Glomerulonephritis - membranoproliferative; MPGN type I; MPGN type II
Causes
Glomerulonephritis is inflammation of the glomeruli. These structures of the kidney help filter wastes and fluids from the blood to form urine.
Membranoproliferative GN is a form of glomerulonephritis caused by an abnormal immune response. Deposits of antibodies build up in a part of the kidneys called the glomerular basement membrane. This membrane helps filter wastes and extra fluid from the blood.
Damage to this membrane affects the kidney's ability to create urine normally. It may allow blood and protein to leak into the urine. If enough protein leaks into the urine, fluid may leak out of the blood vessels into body tissues, leading to swelling (edema). Nitrogen waste products may also build up in the blood (azotemia).
There are two forms of membranoproliferative GN:
- Membranoproliferative GN I
- Membranoproliferative GN II
Most people with the disease have type I. Membranoproliferative GN II is much less common. It also tends to get worse faster than membranoproliferative GN I.
Many cases of membranoproliferative GN are due to causes such as:
- Autoimmune diseases (systemic lupus erythematosus, scleroderma, Sjogren syndrome, sarcoidosis)
- Cancer (leukemia, lymphoma)
- Infections (hepatitis B, hepatitis C, endocarditis, malaria)
The conditions mostly affect people ages 8 to 16.
Symptoms
- Blood in the urine
- Changes in mental status such as decreased alertness or decreased concentration
- Cloudy urine
- Dark urine (smoke, cola, or tea colored)
- Decrease in urine volume
- Foamy urine
- Swelling of any part of the body
Exams and Tests
Your doctor or nurse will examine you. You may have swelling (usually in the legs), along with other signs of fluid overload, such as abnormal sounds when listening to the heart and lungs with a stethoscope.
Blood pressure is often high.
Membranoproliferative GN may be seen as:
- Abnormal urinalysis without symptoms
- Acute nephritic syndrome
- Nephrotic syndrome
The following tests help confirm the diagnosis:
- BUN and creatinine blood test
- Blood complement C3 level
- Blood complement levels
- Urinalysis
- Urine protein
A kidney biopsy confirms the diagnosis of membranoproliferative GN I or II.
Treatment
Treatment depends on the symptoms. The goals of treatment are to reduce symptoms, prevent complications, and slow the progression of the disorder.
You may need a change in diet. This may include limiting salt, fluids, or protein to help control high blood pressure, swelling, and the buildup of waste products in the blood.
Medicines that may be prescribed include:
- Blood pressure medications
- Dipyridamole, with or without aspirin
- Diuretics
- Medications to suppress the immune system, such as cyclophosphamide
- Steroids
Treatment is more effective in children than in adults. Dialysis or kidney transplant may eventually be needed to manage kidney failure.
Outlook (Prognosis)
The disorder often slowly gets worse and eventually results in chronic kidney failure.
Half of patients with this condition develop chronic kidney failure within 10 years. This is more likely in those who have higher levels of protein in their urine.
Possible Complications
- Acute nephritic syndrome
- Acute renal failure
- Chronic kidney disease
- End-stage kidney disease
- Nephrotic syndrome
When to Contact a Medical Professional
Call for an appointment with your health care provider if:
- You have symptoms of this condition
- Your symptoms get worse or do not go away
- You develop new symptoms, including decreased urine output
Prevention
Prevention is often not possible.
References
Appel GB, Radhakrishnan J. Glomerular disorders and nephrotic syndromes. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed.Philadelphia, PA: Saunders Elsevier; 2011:chap 123.
Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM,eds. Brenner & Rector's The Kidney. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 31.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Herbert Y. Lin, MD, PHD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
