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Immunofluorescence-based reclassification of idiopathic membranoproliferative glomerulonephritis: Insights from a
Rahma Rashid1, Ranil H Shrestha2, Tabassum Elahi2
1Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan.
Background:
Membranoproliferative glomerulonephritis (MPGN) is a rare form of glomerular injury with variable prognosis, defined by immunoglobulin and/or complement deposits in the mesangium and basement membranes on immunofluorescence microscopy.
Aim:
To categorize it into immune complex-mediated MPGN (IC-MPGN) or complement-mediated MPGN (C-MPGN) types and to evaluate the clinical significance of this classification.
Methods:
This retrospective cohort study evaluated biopsy-confirmed primary MPGN cases in adults diagnosed between January 2010 and December 2021 at the Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Patients were followed for at least 36 months post-biopsy, and secondary causes were excluded. Based on immunofluorescence microscopy findings, cases were categorized as IC-MPGN or C-MPGN. Clinicopathological features and renal outcomes were compared between the two groups.
Results:
A total of 128 patients with primary MPGN were included, of whom 100 (78.1%) were reclassified as IC-MPGN and 28 (21.9%) as C-MPGN. No statistically significant differences were observed between the groups in gender distribution, clinical presentation, biopsy indications, histopathological findings, or renal function at diagnosis, except for a modest age difference (median 33.5 years vs 38 years, P = 0.029). Vascular pathology was significantly more frequent in C-MPGN, and C3 deposition was stronger and serum C3 levels lower, consistent with complement consumption. Immunosuppressive therapy was administered to 51 (51%) IC-MPGN patients and 19 (67.8%) C-MPGN patients. At 36 months, IC-MPGN patients showed numerically higher rates of complete or partial remission (62% vs 60.7%), though this difference did not reach statistical significance (log-rank test: P = 0.40). Progression to end-stage kidney disease and dialysis dependence was comparable between the two groups.
Conclusion:
The majority of MPGN cases were reclassified as IC-MPGN, which showed numerically higher remission rates. Overall, the clinicopathological features at diagnosis were similar between the two groups, though C-MPGN, a less frequent subtype, was associated with vascular pathology and stronger complement deposition, and a poorer medium-term prognosis.
