Case Report of Spontaneous Remission of Biopsy-Proven Idiopathic Immune
Complex-Mediated Membranoproliferative Glomerulonephritis
#MMPMID28868298
Shah R
; Segal MS
; Wilkowski MJ
Case Rep Nephrol Dial
2017[May]; 7
(2
): 81-90
PMID28868298
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Membranoproliferative glomerulonephritis (MPGN) is a histopathologic diagnosis
causing microscopic hematuria, nephrotic range proteinuria, and chronic renal
failure. Current understanding divides pathogenesis into two broad categories:
immune complex mediated and complement mediated (now termed C3 glomerulopathy).
The term idiopathic immune complex-mediated MPGN would apply to a patient without
an identifiable source of immune complex production and no evidence of C3
glomerulopathy. Presented is a patient with idiopathic immune complex mediated
MPGN and her clinical course. The patient opted for conservative therapy with
losartan, carvedilol, chlorthalidone, and atorvastatin. Nephrotic range
proteinuria of 8.7 g per day resolved over 5 months, with improvement of serum
from 3.3 to 1.2 mg/dL. Remission continues at follow-up 21 months after biopsy.
For idiopathic immune complex-mediated MPGN, resorting to empiric
immunosuppression therapy may not be the best option. As this patient
demonstrates, a conservative approach of blood pressure control with
anti-renin-angiotensin agents, control of lipids, and watchful follow-up can be
successful.
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