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Evaluation and treatment of membranoproliferative glomerulonephritis

Fernando C Fervenza, MD, PhD
Sanjeev Sethi, MD, PhD
Section Editor
Richard J Glassock, MD, MACP
Deputy Editor
Albert Q Lam, MD


Membranoproliferative glomerulonephritis (MPGN), also known as mesangiocapillary glomerulonephritis, is a pattern of glomerular injury viewed by light microscopy. Its name is derived from the characteristic histologic changes including hypercellularity and thickening of the glomerular basement membrane, often leading to a lobular appearance of the glomerular tuft (picture 1A-B) [1]. (See "Clinical presentation, classification, and causes of membranoproliferative glomerulonephritis".)

The treatment of MPGN depends upon the underlying cause since most patients have either a circulating immune complex disease or dysregulation of the alternative complement pathway. These issues will be reviewed here with the exception of MPGN due to complement-mediated disease (C3 glomerulopathies, including C3 glomerulonephritis and dense deposit disease, and C4 glomerulopathy). These disorders, as well as the treatment of recurrent MPGN after kidney transplantation, are discussed separately. (See "C3 glomerulopathies: Dense deposit disease and C3 glomerulonephritis" and "C4 glomerulopathy" and "Recurrence of idiopathic immune complex-mediated membranoproliferative glomerulonephritis (MPGN) after transplantation".)


Membranoproliferative glomerulonephritis (MPGN) was originally classified according to the findings on electron microscopy. (See "Clinical presentation, classification, and causes of membranoproliferative glomerulonephritis", section on 'Classification based upon electron microscopy'.)

Type I is characterized by discrete immune deposits in the mesangium and subendothelial space, similar to that seen in lupus nephritis (picture 2). The deposits are thought to reflect the deposition of circulating immune complexes.

Type II (also called dense deposit disease) is characterized by continuous, dense ribbon-like deposits along the basement membranes of the glomeruli, tubules, and Bowman's capsule (picture 3).

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Literature review current through: Nov 2017. | This topic last updated: Nov 07, 2016.
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