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Development of chronic renal failure in adult pure mesangial glomerulonephritis
Ladislava Greevska1, Momir Polenakovic
1Department of Nephrology, Clinical Center, Skopje, R. Macedonia.
Abstract:
Mesangial glomerulonephritis is uncommon histopathological pattern as a part of primary glomerular diseases. 64 (6.6%) patients of 968 non-transplant renal biopsies done at our department presented pure mesangial glomerulonephritis, without evidence of IgA nephropathy or systemic disorders. 22/64 (34.7%) of the patients presented with nephrotic syndrome, 12 were male, 10 female, aged 33.32 +/- 3.14. All of them were treated with steroids, 3/22 revealed complete remission, 4/22 partial remission and 6/22 did not respond to steroids, and later combined therapy with cyclophosphamide and cyclosporine. They developed end-stage renal failure within 4-8 years. 42/64 (65.3%) patients, 26 male, 16 female, aged 32.29 +/- 1.74 presented with erythruria and non-nephrotic proteinuria. Because of the absence of nephrotic syndrome only anti-hypertensive treatment was performed in this group of patients if necessary. One patient died because of hypertension complication (intracranial hemorrhage), two developed end-stage renal failure follow-up of 12 and 6 years.
Insights
Pure mesangial glomerulonephritis is an uncommon kidney disease. Steroid treatment showed limited efficacy in nephrotic patients, with many progressing to end-stage renal failure, while non-nephrotic patients had a better prognosis.
Area of Science:
- Nephrology
- Pathology
- Internal Medicine
Background:
- Mesangial glomerulonephritis is an infrequent histopathological finding in primary glomerular diseases.
- This study focuses on pure mesangial glomerulonephritis, excluding IgA nephropathy and systemic disorders.
Purpose of the Study:
- To investigate the clinical presentation, treatment outcomes, and prognosis of pure mesangial glomerulonephritis.
- To differentiate outcomes based on the presence or absence of nephrotic syndrome.
Main Methods:
- Retrospective analysis of 64 patients with pure mesangial glomerulonephritis from 968 non-transplant renal biopsies.
- Categorization of patients into nephrotic and non-nephrotic groups.
- Review of treatment responses and long-term renal outcomes.
Main Results:
- 34.7% of patients presented with nephrotic syndrome; steroid therapy yielded low remission rates (27.3%), with 27.3% progressing to end-stage renal failure within 4-8 years.
- 65.3% presented with non-nephrotic proteinuria and erythruria; these patients generally received only anti-hypertensive treatment, with a lower rate of renal failure.
- One non-nephrotic patient died from hypertensive complications.
Conclusions:
- Pure mesangial glomerulonephritis with nephrotic syndrome has a poor prognosis despite immunosuppressive therapy.
- Non-nephrotic pure mesangial glomerulonephritis appears to have a more favorable outcome with supportive care.
- Further research is warranted to optimize treatment strategies for mesangial glomerulonephritis.