A clinicopathological study of membranoproliferative glomerulonephritis in the light of new evolving classification
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Background: Membranoproliferative glomerulonephritis (MPGN) is a progressive disease with poor prognosis. An emerging consensus on classification based on immunofluorescence findings separates MPGN into two groups: immune complex-mediated MPGN and complement-mediated MPGN. This study was undertaken to investigate the clinical, biochemical, and histopathological parameters in-between these two groups histologically diagnosed as MPGN previously. Materials and Methods: We conduct a retrospective cross-sectional study carried out at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period from June 2016 to December 2017. A total of 67 histologically diagnosed MPGN cases were enrolled in the study. Immunofluorescence evaluations were performed and correlated with retrospective clinical and biochemical data. Results: Immune complex-mediated MPGN and complement-mediated MPGN cannot be differentiated by histopathology. There were no significant differences between clinical (age, sex, clinical presentation) and biochemical (serum creatinine, C3 level, C4 level) parameters between immune complex-mediated MPGN and complement-mediated MPGN. Conclusion: Clinical and biochemical and histopathological parameters in-between these two groups of MPGN show no significant difference.Keywords:
Membranoproliferative glomerulonephritis
Histopathology
Immunofluorescence
106 selected kidneys removed at autopsy were studied by direct immunofluorescence using polyvalent antisera against human immunoglobulins, light chains, complement fractions and fibrinogen. The immunofluorescence was a suitable method to solve differential diagnostic problems that arose at autopsy. The diagnostic value was the most obvious in cases of immunologically mediated renal diseases and in immunologically mediated systemic diseases involving the kidneys. Negative immunofluorescence findings were also useful to determine the pathogenesis of renal lesions, especially in vasculopathies. The immunofluorescence of postmortem material showed similar disturbances to that obtained with biopsy material. At various sites, especially in the tubulo-interstitium, additional electron microscopical study was sometimes needed to localise the immune deposits exactly. The fluorescent microscopical examination of frozen sections of kidney taken at necropsy turned out to be more adequate than the immunoperoxidase examination of formalin-fixed, paraffin-embedded sections.
Immunoperoxidase
Immunofluorescence
Direct fluorescent antibody
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Membranoproliferative glomerulonephritis
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Membranoproliferative glomerulonephritis
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Background: New classification for membranoproliferative glomerulonephritis has been proposed in the literature. The aim of this study was to compare the clinical, biochemical, etiology and renal biopsy findings of these patients grouped by immunofluorescence as proposed by the new classification. Methods: Patients with renal biopsy-proven membranoproliferative glomerulonephritis unrelated to systemic lupus erythematosus, diagnosed between 1999 and 2014. The patients were divided according to immunofluorescence: Immunoglobulin positive group, C3 positive only and negative immunofluorescence group. Results: We evaluated 92 patients, the majority of which were in the immunoglobulin positive group. Infectious diseases, hepatitis C virus and schistosomiasis, were the most frequent etiology. A negative immunofluorescence group had more vascular involvement in renal biopsy compare with others groups. Conclusions: The only difference between the groups was higher vascular involvement in renal biopsy in negative immunofluorescence group. These new classification was satisfactory for the finding of etiology in one part of the cases.
Membranoproliferative glomerulonephritis
Immunofluorescence
Etiology
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Membranoproliferative glomerulonephritis
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Renal diseases other than diabetic nephropathy can be found in diabetic patients who have undergone renal biopsy. Various forms of primary and secondary glomerular diseases were reported, but membranoproliferative glomerulonephritis was rare.Analyzing data at our Department for the past three years, we noted 18 patients with primary membranoproliferative glomerulonephritis and 4 associated with diabetic nephropathy.Nodular glomerulosclerosis with diffuse membranoproliferative glomerulonephritis was registered in two patients and a diffuse form of diabetic nephropathy with a combination of segmental and diffuse changes characteristic of membranoproliferative glomerulonephritis in the other two patients.Analyzing what can be common for these two diseases we can conclude that they are at least three disorders: 1. hyperperfusion injury, hallmark for the diabetic nephropathy, but also with the highest incidence in membranoproliferative glomerulonephritis than in the other glomerulonephritides; 2. mesangial matrix expansion, and; 3. thickening of all extracellular membranes.
Membranoproliferative glomerulonephritis
Membranous Nephropathy
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Glomerulonephritis is a rare complication of primary Sjögren's syndrome. When glomerulonephritis does occur, it is usually due to membranous, focal proliferative, or membranoproliferative lesions. There have been fewer than 20 reported cases of glomerulonephritis in primary Sjögren's syndrome, only three of which have been membranoproliferative. We report a case of primary Sjögren's syndrome complicated by Type III membranoproliferative glomerulonephritis, a specific type of mesangiocapillary glomerulonephritis never before reported in this setting, and describe a clinical course terminating in rapidly progressive renal failure.
Membranoproliferative glomerulonephritis
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近年，膜性増殖性糸球体腎炎（membranoproliferative glomerulonephritis：MPGN）に補体第二経路の制御異常によるC3腎炎が含まれることが明らかとなった．MPGNII型（Dense deposit病）と共にC3腎症と提唱されている．C3腎症は補体第二経路の制御因子の遺伝子変異や自己抗体の検索が必要である．免疫複合体が関与するMPGNは基礎疾患に対する治療が重要である．
Membranoproliferative glomerulonephritis
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Six cases of membranoproliferative glomerulonephritis with dense deposits are reported. This entity has clinical, immunological and morphological characteristics which make it a variant of the membranoproliferative glomerulonephritis: a very frequent disease among our population.
Membranoproliferative glomerulonephritis
Basal (medicine)
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Membranoproliferative glomerulonephritis
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