Membranoproliferative Glomerulonephritis

Membranoproliferative glomerulonephritis (MPGN), also known as mesangiocapillary glomerulonephritis, is a complex and rare cause of glomerular disease. Its name describes the main pathological features of this entity: thickening of the glomerular basement membrane due to the deposition of immune complexes and cellular proliferation caused by the influx of mesangial cells and inflammatory cells, mainly monocytes. Thus, MPGN is not a clinical entity per se but rather the pathological expression of different clinical processes. This finding should prompt clinicians to search for a possible underlying etiology. New classifications based on pathophysiology and immune deposition on renal biopsy are now accepted. MPGN accounts for 4–5% of all glomerular diseases. The prognosis is usually poor, with an estimated renal survival of 60–65% at 10–15 years after initial renal biopsy, regardless of treatment. Signs of prognostic value are as follows: nephrotic syndrome, renal failure, arterial hypertension, crescents, and tubulointerstitial involvement on biopsy. Corticosteroids are the only treatment that has shown a prognostic improvement in this disease in children, but not in adults. Recently, treatment with mycophenolate or rituximab has been associated with an improvement in prognosis.