Mesangial proliferative glomerulonephritis

Alternative names
Glomerulonephritis - mesangial proliferative; Mesangial proliferative GN

Definition
Mesangial proliferative glomerulonephritis is a kidney disorder characterized by swelling and blood in the urine (dark urine). It is caused by inflammation of an internal kidney structure (glomerulus), and specifically an increase in number of certain glomerular cells (mesangial cells), accompanied by antibody deposits in the mesangium layer of the glomerular capillary.

Causes, incidence, and risk factors

Mesangial proliferative glomerulonephritis is a form of glomerulonephritis (inflammation of the kidney glomeruli). The mesangial cells (part of the glomerular capillaries) increase in size and number, giving the glomeruli a lumpy appearance.

The mechanism that triggers the disorder is unknown, but it is believed to be some type of immune response, because inflammation of the glomeruli is associated with deposits of antibodies.

The disorder usually causes nephrotic syndrome (protein loss in the urine and swelling of the body). It may be present as acute, chronic, or rapidly progressive glomerulonephritis, and may progress to chronic kidney failure.

This is a relatively uncommon disorder. The term mesangial proliferative GN is actually a description of the microscopic pattern of this disease.

It may be seen more commonly in lupus patients who develop GN, and in patients who have IgA mediated kidney disease (see IgA nephropathy). It can affect both adults and children. Men may be affected slightly more often than women.

Symptoms

     
  • Swelling (edema)       o Around the eyes       o In the extremities, especially the feet and ankles       o In the abdomen       o General  
  • Foamy appearance of the urine  
  • Bloody or dark urine  
  • Involuntary weight gain (from retention of fluid)  
  • Poor appetite  
  • High blood pressure

Signs and tests
Examination is nonspecific, except for edema. Signs of acute or chronic renal failure may be present, including high blood pressure, low urine output, and fluid overload.

     
  • Urinalysis may reveal blood or variable amounts of protein.  
  • Fats may be present in the urine.  
  • BUN and serum creatinine may be elevated, if renal failure is present.  
  • Blood lipids may be elevated.  
  • Blood protein levels may be decreased.  
  • Renal (kidney) biopsy confirms mesangial proliferative glomerulonephritis.

Treatment
Treatment goals are to relieve symptoms and prevent complications. The disorder is usually chronic, requiring prolonged treatment.

Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications may be given in an attempt to control symptoms and retard progression of the disorder. Although the presence of antibodies indicates there is some type of immune response causing the disorder, suppression of the immune system with corticosteroids and immunosuppressives may not reduce symptoms in all cases.

Treatment of high blood cholesterol and triglyceride levels may be recommended to reduce the development of atherosclerosis. Dietary limitation of cholesterol and saturated fats may be of only limited benefit. This is because high levels of cholesterol and triglyceride associated with this disorder appear to be caused by overproduction by the liver, rather than excessive intake of fats. Medications to reduce cholesterol and triglycerides may be recommended.

High-protein diets are of debatable value. In many patients, reducing the amount of protein in diet produces a decrease in urine protein. A moderate-protein diet (1 gram per kilogram of body weight per day) is usually recommended. In cases of kidney failure, a low-protein diet is recommended to reduce the accumulation of dangerous nitrogen containing wastes (a by-product of protein metabolism).

Sodium (salt) and fluids may be restricted to help control swelling. Vitamin D may need to be replaced if nephrotic syndrome develops that is unresponsive to therapy.

Expectations (prognosis)
The outcome varies. The disorder may be acute and short-term, or chronic and unresponsive to therapy. Complications can affect the outcome.

Complications

     
  • Atherosclerosis and related heart diseases  
  • Acute renal failure  
  • Chronic renal failure  
  • Infections, including pneumococcal pneumonia  
  • Malnutrition  
  • Fluid overload, congestive heart failure, pulmonary edema

Calling your health care provider
Call your health care provider if symptoms indicating mesangial proliferative glomerulonephritis may be present.

Call your health care provider if decreased urine output, or other new symptoms develop.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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