Pure Mesangial Proliferative Glomerulonephritis

Andal, A; Saxena, Sunita; Chellani, Harish; S, Sharma

doi:10.1159/000185315

Cited by 11 publications

(1 citation statement)

References 4 publications

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“…The association of MH with NS has been established previously by various investigators, most elegantly by Joh et al [13], who showed that MH sensitivity was associated with hematuria or proteinuria severity. Another study in 45 children with idiopathic NS showed that MH in association with NS predicted a lower response to corticosteroids, higher BP, and lower GFR [14]. Our results showed that the majority of those who presented with or later developed NS had multiple relapses, with many developing steroid dependency or resistance, subsequently requiring alkylating agents, calcineurin inhibitors, or CYP 450 inhibitors for treatment of NS.…”

Section: Discussionmentioning

confidence: 46%

Mesangial hypercellularity in children: presenting features and outcomes

Silverstein

Craver

2008

Pediatr Nephrol

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Mesangial hypercellularity (MH), in the absence of sclerosis or immune deposition, was a common finding on renal biopsy in our center. We studied 66 children with predominant MH. Among all patients older than 2.7 years, blood pressure (BP) percentile and glomerular filtration rate (GFR) remained stable. Serum albumin (Alb) trended higher (3.0+/-0.2 start vs. 3.4+/-0.2 end g/dl, p=0.06) and urine protein/creatinine lower (4.2+/-0.9 start vs. 2.3+/-0.9 end mg/mg, p=0.18) at the end of the study period. The proportion with stage 1 CKD remained constant: 94% start vs. 92% end. At end, Alb was lower in patients referred for nephrotic syndrome (NS): 4.4+/-0.3 hematuria vs. 4.2+/-0.2 proteinuria vs. 2.8+/-0.3 NS g/dl, p<0.05 vs. both. Alb was lower (p=0.03) and urine protein/creatinine trended higher in patients with diffuse foot-process fusion (FPF). Twenty-five percent of patients with focal FPF developed NS, all had relapses, and 63% were steroid sensitive (SS). All but one with diffuse FPF presented with NS; 86% had relapses (mean 1 year) and 63% were SS. GFR trended higher at the end in those with matrix thickening (mat) (119.6+/-4.7 no mat vs. 129.1+/-2.6 mat ml/min per 1.73 m2, p=0.1). Those without mat were less SS (59% no mat vs. 80% mat) and were more likely to require alkylating agents (Alk) for NS. Among those with positive immunofluorescence (IF), 82% had immunoglobulin M (IgM) alone; those with positive IF were more SS and needed Alk for NS. MH predicts a favorable prognosis. FPF predicts NS and multiple relapses.

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Section: Discussionmentioning

confidence: 46%

Mesangial hypercellularity in children: presenting features and outcomes

Silverstein

Craver

2008

Pediatr Nephrol

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Changing patterns in the histopathology of idiopathic nephrotic syndrome in children

Bonilla–Félix

Parra

Dajani

et al. 1999

Kidney International

184

144

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Management of minimal lesion glomerulonephritis: Evidence-based recommendations

Bargman

1999

Kidney International

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Management of minimal lesion glomerulonephritis: Evidenceinvestigators include staining with IgM, and there may based recommendations. The treatment of idiopathic minimal be a spectrum of disease between minimal lesion and lesion disease in children has been extensively studied in ran-IgM mesangial proliferative glomerulonephritis. Indeed, domized controlled trials, however, there is less information this is a potential cause of confusion because some studavailable for adults. This article summarizes evidence-based ies allow mesangial proliferation and/or staining with recommendations for management. The first attack should be treated with prednisone or prednisolone at 60 mg/m 2 per day IgM as a variant of minimal lesion, whereas others do (up to a maximum of 80 mg/day) for four to six weeks, followed not. Although deposition of IgM does not appear to by 40 mg/m 2 of prednisone every other day for another four change prognosis, mesangial hypercellularity is associto six weeks (grade A). Relapse should be treated with 60 mg/ ated with late nonresponse [5]. Others have not found an m 2 /day of prednisone (up to 80 mg/day) only until the urine association between histology and postbiopsy course [6]. becomes protein free for three days, and then an alternate day regimen of 40 mg/m 2 should be used for another month (grade A). Patients with frequently relapsing disease will have a sig-Methods nificant reduction in relapse frequency after eight weeks of an The evidence used in compiling these recommendaalkylating agent (grade A). Less rigorous studies have sugtions was obtained from published trials found in a MEDgested benefit with long-term, alternate-day corticosteroid (grade D) or the antihelminthic agent levamisole (grade D). LINE search of the English language literature. Second-For patients with steroid-dependent disease, an 8-or 12-week ary references from the bibliography of the initial studies course with cyclophosphamide can induce remission (grade were also perused, as were personal files. Recommenda-D). In true steroid-resistant disease, observational studies have tions were graded from A to D, based on the level of suggested that a course of cyclosporine may sometimes induce evidence of the supporting studies. remission or restore steroid responsiveness (grade D). Large retrospective studies in adults suggest that therapeutic response is slower than in children, but adults experience fewer relapses and more prolonged remission.

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Pure Mesangial Proliferative Glomerulonephritis

Cited by 11 publications

References 4 publications

Mesangial hypercellularity in children: presenting features and outcomes

Mesangial hypercellularity in children: presenting features and outcomes

Changing patterns in the histopathology of idiopathic nephrotic syndrome in children

Management of minimal lesion glomerulonephritis: Evidence-based recommendations

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