Mesangioproliferative glomerulonephritis: an important glomerulonephritis in nephrotic syndrome of young adult.
Mesangioproliferative glomerulonephritis (MesPGN) consists 10% of the total renal biopsy of glomerulonephritis. Aim of the present study was to find out clinicopathological changes in MesPGN and differences between diffuse and focal variety. MesPGN was seen mostly in young adults with mean age of 28.63 years for males and 26.3 years for females. Male predominance was noted (M:F ratio - 1.4:1). About 70.83% patient presented with edema feet, followed by hypertension (29.19%), fever (16.66%), oliguria, nausea and vomiting (10.41%). Urine analysis in 50 patients revealed that 70% patients presented with nephrotic-range proteinuria, 36% patients with microscopic hematuria and 56% patients with leukocyturia. Statistically, no significant difference was found in clinical features of diffuse and focal MesPGN. Microscopic comparison between diffuse and focal variety showed that significant increase of focal glomerular basement membrane thickening, focal endothelial cell proliferation, focal smooth muscle hyperplasia, hyaline sclerosis and vasculitis was more common in diffuse variety. In focal variety, Capillary loop congestion, periglomerulitis, cloudy swelling and vacuolar degeneration in tubules were significantly more as compared to diffuse variety. Details of the clinical features, special laboratory tests and histological details revealed that diffuse variety had systemic diseases, which included Wegner's granulomatosis, microscopic polyangitis, Henoch's schonlein purpura, systemic lupus erythematosus (two cases) and one case each of Kimura's disease, pyelonephritis and tuberculosis. Only one case of focal MesPGN showed tuberculosis. Thus, our study concludes that MesPGN is an important cause of nephrotic syndrome among young adults. Secondly, search for some other diseases should be made and thirdly, if biopsy shows focal mesangial cell proliferations in minimal change glomerulonephritis (MCGN), it should be diagnosed as focal MesPGN rather than MCGN because these cases show recurrences.
Usha
UGC Advanced Immunodiagnostic Training and Research Center, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. usha_path@bhu.ac.in
Kumar
Sunil
S
Singh
R G
RG
Tapas
Sagar
S
Prakash
Jai
J
Garbyal
R S
RS
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D005920:Glomerular Mesangium / Q000473:pathology*; D005921:Glomerulonephritis / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology*; D012737:Sex Factors; D014556:Urine / Q000737:chemistry / Q000166:cytology; D055815:Young Adult