MPGN is a glomerular lesion

1. Membranoproliferative GlomeruloNephritis
By
Salwa Mahmoud Elwasif, M.D.
Fellow of Internal Medicine and Nephrology

2. Nephrology
Kidney disease
Glomerular
proliferative
Non-
proliferative
Tubules interstitium Vascular

6. The reality

9. MPGN pattern:
Three characteristic histopathologic findings:
• Proliferation of mesangial and endothelial cells and
expansion of the mesangial matrix
• Thickening of the peripheral capillary walls by subendothelial
immune deposits and/or intramembranous dense deposits
• Mesangial interposition into the capillary wall, giving rise to a
double-contour or tram-track appearance on light
microscopy

10. Epidemiology
• 6-12% of US patients receiving renal
biopsies to evaluate glomerular diseases.
• 7% of children and 12% of adults with
idiopathic nephrotic syndrome.

11. Racial, sexual, and age differences
• predominantly affects the white population.
• Type I:
• Type II:

12. Prognosis
Predictors for poor prognosis:
• Nephrotic syndrome
• hypertension at presentation
• low GFR at 1 year
• older age.

13. Histologic characteristics of poor prognosis
• crescent formation
• interstitial fibrosis
• tubular atrophy
• multiple sclerotic glomeruli
hypocomplementemia is not a predictor of
disease severity or prognosis.

14. Traditional classification

15. Traditional classification

16. Traditional classification

19. Daccueil et al, AJKD © National Kidney Foundation.

27. Clinical picture
•Asymptomatic proteinuria and hematuria detected on routine urinalysis (23-
30%), prompting further investigations
•Nephrotic syndrome (42-67%): Periorbital or dependent edema may develop in
patients with nephritic or nephrotic presentations; anasarca is present in a few
patients
•Acute nephritic syndrome (16-30%): Patients with an acute nephritic
presentation may develop a decrease in urine output (oliguria)
•Recurrent episodes of gross hematuria (10-20%): Patients may have episodes
of gross hematuria similar to those observed with IgA nephropathy—these
episodes are usually associated with upper respiratory infections
•Azotemia: Patients may develop acute kidney injury with the acute nephritic
syndrome, which usually correlates with crescentic transformation on histology;
other patients may present with advanced chronic renal insufficiency

29. D.D
• Acute Glomerulonephritis
• IgA Nephropathy
• Lupus Nephritis
• Poststreptococcal Glomerulonephritis
• Rapidly Progressive Glomerulonephritis

31. Recurrent disease after
transplantation
• MPGN type I disease, 30-70% of which 30-40% lead to
graft failure.
• MPGN type II ranges from 50% to 100%; although
recurrences may be mild, eventually 50% of the grafts fail.
• MPGN type III are not known.
• Recurrent MPGN needs to be differentiated from
transplant glomerulopathy, which has a similar histology
but lacks immune deposits.