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What is the treatment of membranoproliferative glomerulonephritis (MPGN)?

Answered by: Dr. Vijay Kher
Consultant Nephrologist,
Indraprastha Apollo Hospitals,
New Delhi

Q. I have been diagnosed to have idiopathic membranoproliferative glomerulonephritis (MPGN) Type 1. I am taking one drug daily (Renitec- an ACE-inhibitor). What are your recommendations on my condition? Will this eventually lead to renal failure, even if I take the drug religiously? My 24-hour urine protein count is aroung 1.8 to 2g. Is this manageable? Is there a possibility that my protein count will normalize? What are the critical signs/factors that I should watch out for? Do I need to take any special diet?

A.  Membranoproliferative glomerulonephritis (MPGN) is mostly a progressive disorder unless it is secondary to an infection which, if treated, may cause resolution of MPGN type I. Hepatitis B & C viral infections have been commonly incriminated. There is no specific treatment for idiopathic MPGN type I except for non-specific drugs like the ones you are taking. Most often the disease is progressive. Meticulous control of blood pressure to less than 130/80 mm Hg will help in retarding the rate of deterioration. Dietary protein intake should be 0.6 - 0.8 gms/kg body weight with high calories intake 35 kcal/kg body weight and the quality of proteins should be high quality proteins (at least 50% of proteins to be high biological proteins like eggs, milk products and meat. The dose of ACE inhibitors need to be optimized to achieve the target level of blood pressure and lowest proteinuria. One should try to prevent malnutrition. You should monitor blood pressure to achieve target levels and kidney function to be monitored 2-3 monthly. Hepatitis B vaccination should be completed with double dose (2 ml) I/M. 4 doses at 0, 1, 2, 6 months.

A.  Membranoproliferative glomerulonephritis (MPGN) is mostly a progressive disorder unless it is secondary to an infection which, if treated, may cause resolution of MPGN type I. Hepatitis B & C viral infections have been commonly incriminated. There is no specific treatment for idiopathic MPGN type I except for non-specific drugs like the ones you are taking. Most often the disease is progressive. Meticulous control of blood pressure to less than 130/80 mm Hg will help in retarding the rate of deterioration. Dietary protein intake should be 0.6 - 0.8 gms/kg body weight with high calories intake 35 kcal/kg body weight and the quality of proteins should be high quality proteins (at least 50% of proteins to be high biological proteins like eggs, milk products and meat. The dose of ACE inhibitors need to be optimized to achieve the target level of blood pressure and lowest proteinuria. One should try to prevent malnutrition. You should monitor blood pressure to achieve target levels and kidney function to be monitored 2-3 monthly. Hepatitis B vaccination should be completed with double dose (2 ml) I/M. 4 doses at 0, 1, 2, 6 months.

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