Abstract: SA-PO239
Idiopathic Membranoproliferative Glomerulonephritis: A Grey Zone
Session Information
- Trainee Case Reports - V
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Lee Loy, Justin, University of Florida Gainesville, Gainesville, Florida, United States
- Malpartida, Freddy Rick, University of Florida Gainesville, Gainesville, Florida, United States
- Zeng, Xu, University of Florida Gainesville, Gainesville, Florida, United States
- Koratala, Abhilash, University of Florida Gainesville, Gainesville, Florida, United States
Introduction
‘Idiopathic’ membranoproliferative glomerulonephritis (MPGN) is rare compared to secondary forms and usually a progressive disease. Studies evaluating the role of steroids were primarily done in children and the data is sparse in adults. Mycophenolate mofetil is effective and can be used as a steroid-sparing agent in the treatment of idiopathic-MPGN.
Case Description
A 22-year-old White man a recent diagnosis of hypertension was referred to Nephrology department for elevated serum creatinine and proteinuria. He was asymptomatic at presentation except for swelling in the legs for few months. Laboratory data was significant for a creatinine of 2mg/dL, serum albumin 2.5g/dL, low serum complements and urine protein-creatinine ratio ~17g/g (Ref: <150 mg/g). Renal biopsy demonstrated MPGN [Figure] with moderate interstitial fibrosis. Secondary causes of MPGN including hepatitis C, lupus, and monoclonal gammopathies were excluded by appropriate tests. He was started on prednisone 80mg/day and proteinuria reduced to ~3.7g/g in 8 weeks. However, he did not tolerate steroid taper and proteinuria worsened. He was then started on Mycophenolate mofetil (MMF) 1000mg twice-a-day with reduction in proteinuria to 1.8g/g in ~6 weeks and serum albumin improved to 3.3g/dL. We plan to continue MMF monotherapy for 2-3 years similar to lupus nephritis treatment.
Discussion
Idiopathic MPGN is very uncommon in developed countries and the evidence base underlying the treatment recommendations is weak. MMF is a potent immunosuppressive agent which is being increasingly used in primary glomerulonephritides, along with lupus nephritis. Current data from small studies including our case supports the use of this agent in idiopathic MPGN.