Reanalysis of membranoproliferative glomerulonephritis patients according to the new classification: a multicenter study

Abstract

BackgroundAll types of membranoproliferative glomerulonephritis (MPGN) are progressive diseases with poor prognoses. Recently, a newly proposed classification of these diseases separated them into immune complex- and complement-mediated diseases. We investigated the frequency of C3 glomerulonephritis among previously diagnosed MPGN patients.MethodsWe conducted a retrospective study of patients diagnosed with MPGN at three tertiary care institutions between 2001 and 2010. We investigated the incidence of complement-mediated disease among patients diagnosed with MPGN. Progressive renal dysfunction was defined as a 50% reduction in the glomerular filtration rate or the need for renal replacement therapy.ResultsAmong the 3,294 renal biopsy patients, 77 (2.3%) were diagnosed with MPGN; 31 cases were excluded, of which seven were diagnosed with systemic lupus nephritis, and the others were not followed for a minimum of 12 months after biopsy. Based on the new classification, complement-mediated MPGN was diagnosed in two patients (4.3%); only one patient developed progressive renal dysfunction. Among the immune complex-mediated MPGN patients, 17 patients developed progressive renal dysfunction. Serum albumin and creatinine levels at the time of MPGN diagnosis were risk factors of renal deterioration, after adjusting for low C3 levels and nephrotic syndrome.ConclusionComplement-mediated glomerulonephritis was present in 4.3% of patients previously diagnosed with MPGN.

Patterns of glomerular disease based on 4-year kidney biopsy material analyzed by light microscopy and immunofluorescence: a retrospective single-center analysis in Poland

“…In addition, more than 70% of patients with MGN presented with NS, followed by about 45% of patients with MPGN. These results are concordant with the recently presented data estimating that NS is present in 60-80% of MGN patients [18] and with the data from a multicenter Korean study on MPGN, where NS was present in 45.6% of MPGN patients [19].…”

Clinical and histological features of patients with membranoproliferative glomerulonephritis classified by immunofluorescence findings

“…There is scarce literature data on analysis of MPGN patients according to the new classification. Woo et al 13 described complement mediated MPGN in 2 patients (4.3%) and immune-mediated MPGN in 39 patients (95.7%) out of 44 diagnosed with MPGN, not distant from our results that shows a predominance of the group with immune complexes.…”

Changes in the complement system in membranoproliferative glomerulonephritis

“…Однако и в работе S. Woo и соавт. [18], проанализировавших более 3000 нефробиопсий, число С3-ГП составило всего 4,3% от всех случаев МПГН, на долю которого приходится 2-10% среди подтвержденных морфологически вариантов ГН [2]. В проведенном нами исследовании в группу С3-ГП вошли 8 пациентов, что составило 19% в структуре нашей популяции больных МПГН и, таким образом, превысило приводимые в литературе значения.…”

“…Тем не менее складывается впечатление о более благоприятном, менее склонном к прогрессированию, течении К-МПГН по сравнению с ИК-МПГН, поскольку поздних стадий ХБП (начиная с III) достигло меньшее число пациентов с С3-ГП (12,5, 15,4 и 29% соответственно). Клиническая характеристика С3-ГП в нашем исследовании полностью соответствует приводимым в литературе описаниям [7,15,18].…”

“…Наши данные о половом составе групп иМПГН и ВН сопоставимы с зарубежными, однако ранее о преобладании женщин среди больных С3-ГП не сообщалось [15,16]. Средний возраст на момент обследования, а также в дебюте ГН в группе С3-ГП оказался наименьшим, что согласуется с данными зарубежных исследований [17,18] НС наблюдался у 80% больных, среди них в 1-й группе у 100%, во 2-й у 61,5%, в 3-й у 85,7% (см. табл.…”