Idiopathic Membranoproliferative Glomerulonephritis Type 1 Refractory to Immunosuppressive Therapy: An Educational Article and Expert Opinion - Abstract
Background: Membranoproliferative glomerulonephritis which is also known as mesangio-capillary and mesangioproliferative glomerulonephritis has been established as a clinical-histopathological entity as early as the 1960s. As early as 2004, Gareth Jones from the United Kingdom and his research group reported a study which showed that treatment of patients with membranoproliferative glomerulonephritis with oral prednisolone and mycophenolate mofetil may help in preserving renal function in patients.Patients and methods: The case of a female who developed primary membranoproliferative glomerulonephritis at about the age of 38 years, and
experienced deterioration in renal function despite immunosuppressive therapy is described. The relevant medical literature was reviewed with aim of determining the available evidence-based therapeutic options.
Results: Following the birth of her fourth child after a pregnancy complicated by hypertension, a 38-year female was experiencing hypertension and gradual elevation of serum creatinine and blood urea. A histopathologic diagnosis of membranoproliferative glomerulonephritis was made after performing renal biopsy, and immunosuppressive therapy with oral prednisolone and mycophenolate mofetil was started. Early during June, 2023, serum creatine was 4.39 mg/dL and blood urea was 85 mg/dL despite the patient was on low protein diet, and therefore the immunosuppressive treatment was stopped and the patient was referred to us. Urea was lowered to 72 mg within a week by adding acacia gum supplementation. The use of dipyridamole plus aspirin was considered in this case based on the evidence provided by Schmidt (1975) and Donadio et al (1984). Conclusion: The current evidence-based expert opinion suggests the use of dipyridamole plus aspirin in cases of membranoproliferative glomerulonephritis not responsive to treatment with oral prednisolone and mycophenolate mofetil.