The Prognostic Value of Some Clinical and Histological Parameters in Membranoproliferative Glomerulonephritis (MPGN)

Belgiojoso, B di; Tarantino, A; Colasanti, G.; Bazzi, Claudio; Guerra, L; Durante, A

doi:10.1159/000180897

Cited by 36 publications

(9 citation statements)

References 9 publications

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“…Our results are in agreement with those of other authors who have reported similar survival rates with smaller numbers of cases [1-3, 5-10, 12, 13, 16], mostly including many children as well as cases with MPGN type II [1][2][3][5][6][7][8][9]12]. Only Barbiano di Belgiojoso et al [4] got more favorable results with a 70% probability of maintaining renal function after 10 years. In contrast, in the studies published by Kincaid-Smith [10] and Mandelanakis et al…”

Section: Discussionsupporting

confidence: 92%

“…The fact that glomerular lesions are not significant for the course of the disease is also shown by earlier studies [1,7,8]: only Barbiano di Belgiojoso et al [4] found a poorer prognosis for lobular glomerulonephritis which corresponds to our grade IV. Even though we observed an unfavorable influence of focal crescent formation (grade V) on the course of MPGN -as other authors before us [1,2,4,7,8,10], we still do not believe that the crescents cause the progression of the disease; rather we suspect that in these cases the almost obligatorily present tubulointerstitial lesions determine the outcome [19]. Among clinical parameters hypertension and an elevated serum creatinine concentration at the time of biopsy are of prognostic significance.…”

Section: Discussionsupporting

confidence: 77%

“…We are not able to provide an explanation for this discrepancy with the studies of other authors who have found the nephrotic syndrome to be associated with a less favorable prognosis. In previous investigations no corre lation could be seen between the frequency and the severity of hypocomplementemia on one hand and the progression/remission of MPGN on the other [1,[4][5][6]10,12,13,16]. In a study of 40 patients Swainson et al [2], however, found a lowersurvival rate in hypocomplementemicas opposed to normocomplementemic MPGN.…”

Section: Discussionmentioning

confidence: 97%

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Long-Term Prognosis of Membranoproliferative Glomerulonephritis Type I

Schmitt

Böhle

Reineke³

et al. 1990

Nephron

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A b stra c t. We carried out a retrospective investigation in 220 patients to assess the influence of various parameters on the long-term course of membranoproliferative glomerulonephritis (MPGN) type 1.50 patients (23%) died during the follow-up period of 59 months on average, in another 57 (26%) end-stage renal failure developed. 54 patients (24%) suffered from chronic renal failure, stable renal function (creatinine below 1.3 mg/dl) was preserved in 59 patients (27%).5 years after biopsy 49% of the patients had already died or needed regular dialysis treatment; after 10 years this proportion increased to 64%. Morphological findings: The outcome was with the exception of focal crescent formations -not determined by the severity of glomerular changes ; the survival rate, however, decreased significantly, if tubulointerstitial lesions were present as defined by acute renal failure, interstitial fibrosis ora combination of both. Clinical parameters; A progressive deterioration of renal function and an increasing number of renal deaths was noticed, when elevated serum creatinine levels at the time of biopsy and high blood pressure values during the follow-up period were observed. 26 patients died from hypertension, 18 of whom before reaching end-stage renal failure. Nephrotic syndrome and the degree of proteinuria as well as antiphlogistic and immunosuppressive treatment did not influence the prognosis of MPGN type 1.Studies on the long-term course of membranoprolifer ative glomerulonephritis (MPGN) have previously been carried out only on small numbers of cases, due to the rarity of the disease [1 13]. The prognosis is generally considered unfavorable [1-16], but there is still uncer tainty about the factors causing the progression to endstage renal failure or even death of the patient. In earlier investigations [14,[17][18][19] we noticed certain correlations between the severity of tubulointerstitial changes at the time of biopsy and renal function in MPGN. Therefore we were interested in determining whether, and to what extent, these changes as well as the clinical parameters blood pressure (BP), creatinine, proteinuria and hematu ria are of prognostic significance.1 Supported by the Deutsche Forschungsgemeinschaft (DFG). Material and MethodsAmong 36000 patients in our renal biopsy registry we found 346 in whom idiopathic MPGN was diagnosed between 1965 and 1984. By further investigations (immunohistology, electron microscopy) 108 patients had to be excluded from our study because primary diagnosis was not correct. They either suffered from other renal disorders (endocapillary/mesangioproliferative/membranous glo merulonephritis) or renal involvement due to underlying diseases such as lupus erythematodes, cryoglobulinemia and monoclonal gammopathy/multiple myeloma: 18 patients with MPGN type II (dense deposits) were also excluded. In the remaining 220 cases (male:female ratio = 1.75:l: mean age 36.4± 15.5 years) the lightmicroscopic diagnosis of MPGN was confirmed and type I (subendothelial deposits) could be ...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Long-Term Prognosis of Membranoproliferative Glomerulonephritis Type I

Schmitt

Böhle

Reineke³

et al. 1990

Nephron

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“…The more probable outcome is chronic deterioration of renal function leading to ESRD in approximately half of patients within 10 yr of diagnosis (22)(23)(24)(25). In some patients, rapid fluctuations in proteinuria occur with episodes of acute renal deterioration in the absence of obvious triggering events; in others, the disease remains stable for years despite persistent proteinuria.…”

Section: Clinical Diagnosismentioning

confidence: 99%

“…C3NeF is nearly always associated with clinical evidence of complement activation such as a reduction in CH50, a decrease in C3, and an increase in C3dg/C3d; however, the relationship among C3NeF, C3 levels, and prognosis is unclear. Some groups report no correlation between C3 levels and clinical course (18,24,26,27), whereas other groups have found persistent hypocomplementemia indicative of a poor prognosis (28,29).…”

Section: Clinical Diagnosismentioning

confidence: 99%

Membranoproliferative Glomerulonephritis Type II (Dense Deposit Disease)

Appel

Cook

Hageman

et al. 2005

Journal of the American Society of Nephrology

351

325

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Mesangiocapillary glomerulonephritis: A long‐term study of 40 cases

Swainson

Robson

Thomson

et al. 1983

The Journal of Pathology

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Forty cases of mesangiocapillary glomerulonephritis are reviewed for whom both light and electron microscopy and full clinical data were available. Immunofluorescence microscopy (IF) was performed on 23 cases and complement screening (CH50, C4 and C3) on 25 cases, with follow-up period of 5-22 y. The results of EM revealed 17 cases (42 per cent.) of Type I and 23 cases (58 per cent.) of Type II MCGN but only 52 per cent. of Type II cases were correctly identified by light microscopy. Epimembranous deposits were seen as frequently in Type II as in Type I (26 per cent. and 30 per cent.) and fragmentation of glomerular capillary basement membranes (GBM) was seen in 27 per cent. of Type I cases. Overall patient survival was 49 per cent. at 10 y and that of patients who presented with nephrotic syndrome was poor (39 per cent. at 10 y). Persistent hypocomplementaemia with C3 Nephritic Factor was present in 40 per cent.; the survival of these patients was less than those with normal complement levels (70 per cent. vs 100 per cent. at 5 y) and they were also more likely to develop renal failure. Renal failure was more likely to develop in those with a creatinine clearance of less than 100 ml/min at presentation and where the biopsy showed substantial crescents in greater than 20 per cent. of glomeruli. Mean CH50, C3 and C4 was lower in the hypocomplementaemic as compared to normocomplementaemic patients, and there were no differences between Type I and Type II. IF showed immunoglobulins and fibrin as well as C3 in both Type I and Type II cases. Our results support the concept of an immune-complex mediated phase in both types of MCGN, and we further suggest that (a) epimembranous deposits are common in both Type I and Type II and (b) cases with fragmentation of the GBM should be designated Type Ia.

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The Prognostic Value of Some Clinical and Histological Parameters in Membranoproliferative Glomerulonephritis (MPGN)

Cited by 36 publications

References 9 publications

Long-Term Prognosis of Membranoproliferative Glomerulonephritis Type I

Long-Term Prognosis of Membranoproliferative Glomerulonephritis Type I

Membranoproliferative Glomerulonephritis Type II (Dense Deposit Disease)

Mesangiocapillary glomerulonephritis: A long‐term study of 40 cases

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