Short-term Renal and Patient Outcomes of Primary Immunoglobulin-associated Mesangiocapillary Glomerulonephritis: Insights from a Developing Country

Overview

Journal World J Nephrol

Publisher Baishideng Publishing Group

Specialty Nephrology

Date 2024 Dec 26

PMID 39723356

Authors

Tabassum Elahi

Saima Ahmed

Muhammed Mubarak

Affiliations

Soon will be listed here.

Abstract

Background: Primary immunoglobulin (Ig)-associated mesangiocapillary glomerulonephritis (Ig-MCGN) is an immune complex glomerulonephritis of unknown etiology. It is a common cause of chronic kidney disease in developing countries. There is limited data available on renal and patient outcomes of this disease from developing countries.

Aim: To determine the short-term renal and patient outcomes of adults with a tissue-confirmed diagnosis of primary Ig-MCGN at a single center in Pakistan.

Methods: A retrospective cohort study of adult patients was conducted on biopsy-proven Ig-MCGN cases diagnosed between 1998 and 2019 at the Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Secondary causes were excluded. The primary endpoint was renal survival without end-stage kidney disease (ESKD) or mortality. The secondary endpoint was the rate of remission during the 2-year follow-up period. Survival curves were made with the use of Kaplan-Meier estimates.

Results: A total of 163 patients were included in the study and their mean follow-up duration was 29.45 months ± 21.28 months. Among baseline characteristics, young age, lower estimated glomerular filtration rate, requirement of kidney replacement therapy, presence of crescents, and severity of interstitial fibrosis and tubular atrophy were found to have a significant association with renal outcomes. The renal outcomes were negatively correlated with the presence of hypertension, level of complements, and degree of proteinuria. In all, 63 (37.4%) patients were treated with steroids and 21 (13%) received combination therapy (cyclophosphamide with steroids). At 2 years, 124 (76.07%) patients were in complete remission or partial remission [56 (34.3%) and 68 (41.71%), respectively], while 32 (19.63%) patients progressed to ESKD and 7 (4.29%) patients died.

Conclusion: The outcomes of primary Ig-MCGN are guarded in Pakistan and require further prospective studies to improve our understanding of this relatively common disease so that more personalized treatment approaches can be developed.

References

Cook H, Pickering M . Clusters Not Classifications: Making Sense of Complement-Mediated Kidney Injury. J Am Soc Nephrol. 2017; 29(1):9-12. PMC: 5748929. DOI: 10.1681/ASN.2017111183. View

Orth S, Ritz E . The nephrotic syndrome. N Engl J Med. 1998; 338(17):1202-11. DOI: 10.1056/NEJM199804233381707. View

Chothia M, Panday A, Coetzee L, Bates W . Outcomes of immunoglobulin-associated mesangiocapillary glomerulonephritis: A South African experience. Nephrology (Carlton). 2020; 25(10):765-774. DOI: 10.1111/nep.13736. View

Nakano M, Karasawa K, Moriyama T, Uchida K, Nitta K . Characteristics of membranoproliferative glomerulonephritis based on a new classification at a single center. Clin Exp Nephrol. 2019; 23(6):852-858. DOI: 10.1007/s10157-019-01716-7. View

Fervenza F, Sethi S, Glassock R . Idiopathic membranoproliferative glomerulonephritis: does it exist?. Nephrol Dial Transplant. 2012; 27(12):4288-94. DOI: 10.1093/ndt/gfs288. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

DAmico G, Ferrario F . Mesangiocapillary glomerulonephritis. J Am Soc Nephrol. 1992; 2(10 Suppl):S159-66. DOI: 10.1681/ASN.V210s159. View

Caliskan Y, Torun E, Tiryaki T, Oruc A, Ozluk Y, Usta Akgul S . Immunosuppressive Treatment in C3 Glomerulopathy: Is it Really Effective?. Am J Nephrol. 2017; 46(2):96-107. DOI: 10.1159/000479012. View

Masani N, Jhaveri K, Fishbane S . Update on membranoproliferative GN. Clin J Am Soc Nephrol. 2014; 9(3):600-8. PMC: 3944764. DOI: 10.2215/CJN.06410613. View

10.

Puri P, Walters G, Fadia M, Konia M, Gibson K, Jiang S . The impact of reclassification of C3 predominant glomerulopathies on diagnostic accuracy, outcome and prognosis in patients with C3 glomerulonephritis. BMC Nephrol. 2020; 21(1):265. PMC: 7351649. DOI: 10.1186/s12882-020-01923-5. View

11.

Chan M, Chan K, Chan P, Fang G, Cheng I . Adult-onset mesangiocapillary glomerulonephritis: a disease with a poor prognosis. Q J Med. 1989; 72(267):599-607. View

12.

Holle J, Berenberg-Gossler L, Wu K, Beringer O, Kropp F, Muller D . Outcome of membranoproliferative glomerulonephritis and C3-glomerulopathy in children and adolescents. Pediatr Nephrol. 2018; 33(12):2289-2298. DOI: 10.1007/s00467-018-4034-z. View

13.

Bomback A . Eculizumab in the treatment of membranoproliferative glomerulonephritis. Nephron Clin Pract. 2014; 128(3-4):270-6. DOI: 10.1159/000368592. View

14.

Faedda R, Satta A, Tanda F, Pirisi M, Bartoli E . Immunosuppressive treatment of membranoproliferative glomerulonephritis. Nephron. 1994; 67(1):59-65. DOI: 10.1159/000187889. View

15.

Sethi S, Fervenza F . Membranoproliferative glomerulonephritis--a new look at an old entity. N Engl J Med. 2012; 366(12):1119-31. DOI: 10.1056/NEJMra1108178. View

16.

Okuda Y, Ishikura K, Hamada R, Harada R, Sakai T, Hamasaki Y . Membranoproliferative glomerulonephritis and C3 glomerulonephritis: frequency, clinical features, and outcome in children. Nephrology (Carlton). 2014; 20(4):286-92. DOI: 10.1111/nep.12382. View

17.

Kawasaki Y, Kanno S, Ono A, Suzuki Y, Ohara S, Sato M . Differences in clinical findings, pathology, and outcomes between C3 glomerulonephritis and membranoproliferative glomerulonephritis. Pediatr Nephrol. 2016; 31(7):1091-9. DOI: 10.1007/s00467-015-3307-z. View

18.

. The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials. Arthritis Rheum. 2006; 54(2):421-32. DOI: 10.1002/art.21625. View

19.

Schmitt H, Bohle A, Reineke T, VOGL W . Long-term prognosis of membranoproliferative glomerulonephritis type I. Significance of clinical and morphological parameters: an investigation of 220 cases. Nephron. 1990; 55(3):242-50. DOI: 10.1159/000185969. View

20.

Sethi S, Nester C, Smith R . Membranoproliferative glomerulonephritis and C3 glomerulopathy: resolving the confusion. Kidney Int. 2011; 81(5):434-41. PMC: 4428602. DOI: 10.1038/ki.2011.399. View