Membranoprolferative GN

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MPGN, MCGN presentation, diagnosis and update management

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Membranoprolferative GN

  1. 1. Membranoprolferative GN
  2. 2. Occur primarily children & young adults. Definition is based on : Mesangial & endothelial cell proliferation Expansion of mesangial matrix Thickened peripheral capillary wall Mesangial interposition into the Cap wall
  3. 3. MPGN I Silver stain Mesangial proliferation and mesangial interposition beneath the capillary loop endothelial cells with formation of "double contours"
  4. 4. MPGN I Electron microscopy
  5. 5. MPGN I Direct immunofluorescence Subendothelial and mesangial deposits of IgG and C3
  6. 6. MPGN II Electron microscopy
  7. 7. MPGN II Direct immunofluorescence There is bright peripheral loop staining with antibody to C3 as well as mesangial staining. Staining for immunoglobulins is often less intense
  8. 8. MPGN III Electron microscopy There are prominent mesangial, subendothelial, and subepithelial electon dense deposits
  9. 9. Mesangial expansion and proliferation Thickend membrane
  10. 10. Primary or secondary which is more common. Idiopathic type : I , II , III depending on: IF staining ,ultrastructural appearance & complement profiles. Hypocomplementaemia is characteristic due to decrease synthesis & consumption.
  11. 11. Type I - Diagnosis by exclusion. - There is discrete deposition in the mesangium & subendothelial space. - NS progressive ESRD 50%,90%in10,20ys - non NS 85% renal survival at 10ys - 30 – 70 % recurrence in RXT
  12. 12. Type II Dense deposits disease Deposition along the memb, tubules & boman`s capsule. - IF +ve for C3 –ve for Ig & complexes - Tram track C3 deposition - High rate of recurrence in RXT 50 – 100 %
  13. 13. Type III Imcomplex disease. ** C3,C5 & properdin deposition. ** Recurrence is unknown in RXT
  14. 14. Presentation Asymptomatic proteinuria & haematouria 20 – 30 % NS 40 – 67 % Acute nephritic syndrome 16 – 30 % Gross haematouria 10 – 20 % Azotaemia
  15. 15.  Diffuse glomerulonephritis  Inflamatory cells infiltrate in glomeruli & interstitium
  16. 16. Treatment Reserved for those with: – proteinuria >3gm/day - interstitial disease - impaired renal function
  17. 17. Diet Normal renal function : normal protein 1 gm/kg/day +urine loss Renal impairment : 0.65 – 0.8 gm/day + urine loss Low cholesterol diet
  18. 18. Non specific treatment BP control Oedema Hyperlipidaemia < 100 mg/dl LDL Infection Thromboembolism
  19. 19. Drug treatment Prednisolone : 2 mg/kg every other day for 1yr then tapered to maintenance of 20 mg every other day for 3 – 10 ys 120 mg on alternate days for12–16 /52 with follow up . After response taper to 20 – 30 mg alternate days for several ys.
  20. 20. Antiplatelets : Can slow the progression *-* Aspirin 975mg/day + dipyridamol 225 mg/day OR *-* Asprin 500 mg/day + dipyridamol 75 mg/day for 3ys.
  21. 21. Cytotoxics : It is not felt that addition of this group would provide further benefits.

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