Q: My 14 years old son is suffering from membranoproliferative glomerulonephritis (MPGN) for the past eight years. His urine protein is ranges from 2-3 g / day, urea is 100, uric acid is 8.8 & creatinine is 0.95. He is taking Losartan (50 mg) and Cardec (5 mg). How long can he avoid renal failure? What diet precaution should be adopted? Urine reports showed 20-30-RBC/HPF and C3 level is low (10) constantly for the past seven years.

A:Membranoproliferative glomerulonephritis (MPGN) is a rare form of kidney disease affecting the children, (especially MPGN Type II also called Dense deposit disease). It results in the swelling and injury to the filtering cells of the kidneys, characterised by increased leakage of protein and blood in the urine. The cause involves abnormal activation of body's certain immune pathway resulting from a genetic defect or lack of a circulating protein, (low serum level of Complement, C3 being reflective of abnormal immune activity). It results in increased deposition of abnormal immune cells on the filtering cells. Managing the disease involves measures to prevent or delay further progression of the disease process, namely strict blood pressure control, treating elevated cholesterol level if present and continued avoidance of exposure to potential kidney toxic medication.

Unfortunately, there is no specific treatment to halt or treat the disease process. However, few case reports have shown the role of Plasma exchange therapy or transfusing fresh frozen plasma, (a kind of blood product) both intended to replace the deficient protein or the factor) in a patient who have flare up of the renal disease activity as obvious by increased leakage of protein in the urine or rising serum creatinine level. Unfortunately, the long term renal disease prognosis is not good and most patients do end up in end stage kidney disease (ESRD) over a period of 12-15 years.