membranoprolferative gn
DESCRIPTION
MPGN, MCGN presentation, diagnosis and update managementTRANSCRIPT
![Page 1: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/1.jpg)
Membranoprolferative GN
![Page 2: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/2.jpg)
Occur primarily children & young adults.Definition is based on :Mesangial & endothelial cell proliferationExpansion of mesangial matrix Thickened peripheral capillary wallMesangial interposition into the Cap wall
![Page 3: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/3.jpg)
Subendothelial deposits characteristic of membranoproliferative glomerulonephritis Type I
![Page 4: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/4.jpg)
MPGN I
Silver stain
Mesangial proliferation and mesangial interposition beneath the capillary loop endothelial cells with formation of "double contours"
![Page 5: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/5.jpg)
MPGN I
Electron microscopy
The deposits are subendothelial and mesangial. There is duplication of the capillary loop basement membrane between the deposits and interposed mesangium, and the endothelial cells
![Page 6: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/6.jpg)
MPGN I
Direct immunofluorescence
Subendothelial and mesangial deposits of IgG and C3
![Page 7: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/7.jpg)
MPGN II
Electron microscopy
The capillary loops contain interrupted linear electron densities in the subendothelial aspect of the basement membrane.
![Page 8: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/8.jpg)
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
![Page 9: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/9.jpg)
MPGN III
Electron microscopy
There are prominent mesangial, subendothelial, and subepithelial electon dense deposits
![Page 10: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/10.jpg)
Mesangial expansion and proliferation
Thickend membrane
![Page 11: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/11.jpg)
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.
![Page 12: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/12.jpg)
![Page 13: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/13.jpg)
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
![Page 14: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/14.jpg)
![Page 15: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/15.jpg)
![Page 16: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/16.jpg)
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 %
![Page 17: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/17.jpg)
![Page 18: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/18.jpg)
Type III
Imcomplex disease.
** C3,C5 & properdin deposition.
** Recurrence is unknown in RXT
![Page 19: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/19.jpg)
![Page 20: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/20.jpg)
Presentation
Asymptomatic proteinuria & haematouria 20 – 30 %NS 40 – 67 %Acute nephritic syndrome 16 – 30 %Gross haematouria 10 – 20 %Azotaemia
![Page 21: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/21.jpg)
Diffuse glomerulonephritis
Inflamatory cells infiltrate in glomeruli & interstitium
![Page 22: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/22.jpg)
![Page 23: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/23.jpg)
![Page 24: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/24.jpg)
Treatment
Reserved for those with:
– proteinuria >3gm/day
- interstitial disease
- impaired renal function
![Page 25: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/25.jpg)
Diet
Normal renal function :normal protein 1 gm/kg/day +urine lossRenal impairment :0.65 – 0.8 gm/day + urine loss Low cholesterol diet
![Page 26: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/26.jpg)
Non specific treatment
BP control Oedema Hyperlipidaemia < 100 mg/dl LDLInfection Thromboembolism
![Page 27: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/27.jpg)
Drug treatment
Prednisolone :2 mg/kg every other day for 1yr then tapered to maintenance of20 mg every other day for 3 – 10 ys120 mg on alternate days for12–16 /52 with follow up .After response taper to 20 – 30 mg alternate days for several ys.
![Page 28: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/28.jpg)
Antiplatelets : Can slow the progression
*-* Aspirin 975mg/day + dipyridamol 225 mg/day OR
*-* Asprin 500 mg/day + dipyridamol 75 mg/day for 3ys.
![Page 29: Membranoprolferative GN](https://reader033.vdocuments.net/reader033/viewer/2022061209/548d9e98b4795964258b469a/html5/thumbnails/29.jpg)
Cytotoxics : It is not felt that addition of
this group would provide further benefits.