OVERVIEW

What is Mesangial Proliferative Glomerulonephritis?

Mesangial proliferative glomerulonephritis (MsPGN) is a pathological morphological term referring to a group of diseases characterized primarily by diffuse proliferation of glomerular mesangial cells and varying degrees of mesangial matrix expansion. In 1977, the World Health Organization officially classified it as a pathological type of glomerulonephritis.

Its clinical manifestations are diverse, mainly including proteinuria and hematuria. The cause may be related to infections, immune factors, etc.

Is Mesangial Proliferative Glomerulonephritis Common?

Mesangial proliferative glomerulonephritis is a common primary glomerular disease in China. Statistics show that it accounts for 24.7%–30.3% of adult primary glomerular disease cases diagnosed via renal biopsy.

This disease is more common in older children and young adults, with a slightly higher incidence in males than females. Nearly half of patients in China often exhibit preceding upper respiratory tract infections.

How Many Types of Mesangial Proliferative Glomerulonephritis Are There?

Based on immunopathology, it is classified into five types:

• Predominantly IgA and complement C3 deposition, the most common type in China;
• Predominantly IgM and C3 deposition, common in Western countries, also known as "IgM nephropathy";
• Predominantly complement C1q deposition, also known as "C1q nephropathy";
• Only complement C3 deposition;
• Negative immunopathology findings, with some scholars suggesting it may be minimal change disease with prominent mesangial cell proliferation.

Is Mesangial Proliferative Glomerulonephritis Hereditary?

No.

SYMPTOMS

What are the common manifestations of mesangial proliferative glomerulonephritis?

The clinical manifestations of mesangial proliferative glomerulonephritis vary and may present as latent glomerular disease (asymptomatic proteinuria and/or hematuria), chronic glomerulonephritis, or "nephrotic syndrome."

Patients with this condition may experience symptoms such as foamy urine, dark-colored urine, and swelling in the lower limbs. In severe cases, nausea, vomiting, poor appetite, and high blood pressure may also occur.

Can mesangial proliferative glomerulonephritis lead to kidney failure?

The likelihood of progression to kidney failure depends on the patient's clinical presentation:

• Patients with latent glomerulonephritis generally have a good prognosis and are unlikely to develop kidney failure.

• Patients with chronic nephritis syndrome often experience slow disease progression. The rate of progression is related to the pathological type (mainly the degree of mesangial matrix expansion), as well as factors such as hypertension, proteinuria, and the patient's diet and lifestyle.

What are the adverse consequences of mesangial proliferative glomerulonephritis?

When patients present with nephrotic syndrome, the following complications may occur:

• Infection: Due to massive protein loss, nutritional imbalance, and glucocorticoid treatment, the body's resistance decreases, leading to infectious diseases. Without timely treatment, this can easily cause relapse and worsening of nephrotic syndrome, and in severe cases, death.

• Thrombosis and embolism: Blood concentration, increased viscosity, and protein loss can disrupt the body's coagulation function. Combined with hyperactive platelet function, diuretic and glucocorticoid use, these factors exacerbate hypercoagulability, increasing the risk of thrombosis and embolism. These complications directly affect the treatment efficacy of nephrotic syndrome.

• Kidney failure: Insufficient effective blood volume reduces renal blood flow, leading to azotemia. A small number of cases may develop acute kidney failure, particularly in patients over 50 years old, presenting with oliguria or anuria, elevated serum creatinine, and electrolyte and acid-base imbalances.

• Protein and lipid metabolism disorders: Long-term protein loss can lead to malnutrition, growth retardation, weakened immunity, and endocrine disorders. Lipid metabolism disorders increase blood viscosity, making thrombosis, embolism, and cardiovascular complications more likely and accelerating kidney damage progression.

CAUSES

How is mesangial proliferative glomerulonephritis caused?

The exact cause remains unclear. Some cases have a history of infection prior to onset, but the role of infection in the disease is uncertain.

Non-immune factors such as hypertension, hyperperfusion (blood flow higher than normal), and platelet dysfunction are also significant contributors to mesangial pathological changes.

DIAGNOSIS

How is mesangial proliferative glomerulonephritis diagnosed?

Kidney biopsy can provide a definitive diagnosis, with re-examination if necessary.

How is mesangial proliferative glomerulonephritis detected?

Initial routine blood tests include complete blood count, rheumatology panel, ANCA, thyroid function, glycated hemoglobin, tumor markers, immunoglobulin complement, hepatitis panel, and serum/urine light chains to rule out secondary causes.

Additionally, kidney biopsy is the most critical and gold-standard diagnostic method. It is recommended when a patient's proteinuria exceeds 1g/24h, provided no contraindications exist.

Are there any precautions for the kidney biopsy required for mesangial proliferative glomerulonephritis?

Kidney biopsy is a vital procedure in nephrology. Local anesthesia is administered during the process, and patients must hold their breath briefly. Discomfort is generally tolerable for most individuals.

Click for more details.

What diseases should mesangial proliferative glomerulonephritis be differentiated from?

Due to its nonspecific clinical presentation and its nature as a pathological diagnosis, mesangial proliferative glomerulonephritis must be distinguished from other kidney diseases with similar manifestations:

• Secondary glomerular diseases: Lupus nephritis, Henoch-Schönlein purpura nephritis, diabetic nephropathy, etc.;

• Primary glomerular diseases: IgA nephropathy, minimal change disease, focal segmental glomerulosclerosis, and other hereditary kidney diseases. Differentiation relies on kidney biopsy, immunoglobulin/complement tests, and clinical history.

TREATMENT

How to treat mesangial proliferative glomerulonephritis?

Different treatment methods are adopted for MsPGN with different clinical manifestations:

• Asymptomatic proteinuria and/or hematuria: Generally, no special treatment is required. Avoid catching cold, overwork, and the use of nephrotoxic drugs. When proteinuria exceeds 1g/24h, angiotensin-converting enzyme inhibitors (ACEIs, such as XX-pril drugs) or angiotensin II receptor blockers (ARBs, such as XX-sartan drugs) may be administered, though there is no evidence-based support. These patients usually have a good prognosis and generally do not experience impaired kidney function.

• Chronic nephritis syndrome: Active control of blood pressure, reduction of proteinuria, and delay of renal function damage are recommended. ACEIs/ARBs are the first choice for blood pressure control, combined with low-dose diuretics. For patients with proteinuria exceeding 1g/24h, blood pressure should be controlled at 125/75 mmHg. If blood pressure remains poorly controlled, calcium channel blockers may be added. ACEIs/ARBs are also used to reduce proteinuria and must be administered at sufficient doses to be effective.

• Nephrotic syndrome: Different treatment plans are adopted based on the severity of the patient's pathology.

• For mild cases, glucocorticoids are the first choice for initial treatment, such as prednisone 1mg/kg/d. For recurrent cases, immunosuppressants may be combined.

• For moderate to severe cases, initial treatment involves glucocorticoids combined with immunosuppressants, and ACEIs/ARBs may be appropriately administered to reduce proteinuria.

Which department should patients with mesangial proliferative glomerulonephritis visit?

Visit the nephrology department of a local hospital.

What should patients with mesangial proliferative glomerulonephritis pay attention to when using ACEIs, ARBs, and other drugs?

Angiotensin-converting enzyme inhibitors (ACEIs, such as XX-pril drugs) and angiotensin II receptor blockers (ARBs, such as XX-sartan drugs) are RAAS blockers. These two types of drugs differ from other antihypertensive drugs because, in addition to lowering blood pressure, they also reduce proteinuria and slow the progression of renal dysfunction.

During use, ACEIs may cause side effects such as irritating cough, elevated blood potassium, increased serum creatinine, and edema. ARBs have similar side effects except for cough. Therefore, during use, it is necessary to monitor blood electrolytes, renal function, and other indicators.

Another important point is that patients with glomerular disease should still use ACEIs or ARBs even if their blood pressure is normal, as these drugs can improve the prognosis of kidney disease.

Can mesangial proliferative glomerulonephritis be cured?

It cannot be cured, but the condition can be controlled and alleviated. After remission, long-term follow-up is still required, including regular checks of renal function, urinalysis, and other indicators.

DIET & LIFESTYLE

What should be paid attention to in the diet for mesangial proliferative glomerulonephritis?

• For patients without abnormal renal function, a high-quality protein diet is recommended. Preferred sources of high-quality protein include eggs, milk, fish, and other animal proteins. Protein intake should be controlled at 1.0g/kg/day. For example, if a patient weighs 50 kg, they should consume 50 g of protein per day. One egg contains approximately 6–7 g of protein, while 100 g of fish provides 13–19.5 g of protein, depending on the type of fish. For patients with renal insufficiency, protein intake may be appropriately reduced.

• Reduce the intake of salt and other seasonings, and consume soy products in moderation.

PREVENTION

How to reduce recurrence of mesangial proliferative glomerulonephritis?

Pay attention to proper rest, avoid fatigue, maintain a reasonable diet, exercise scientifically, enhance physical fitness, improve immunity, and avoid exposure to toxic and harmful substances to prevent various diseases.
Strictly follow the doctor's treatment plan for medication, dosage reduction, and regularly review relevant blood indicators, urine four-quadrant tests, and 24-hour urine protein quantification.

Can mesangial proliferative glomerulonephritis be prevented?

This type of disease cannot be prevented. We can only strive to maintain a balance between work and rest in daily life, follow a healthy diet, exercise scientifically, improve immunity, and avoid exposure to toxic substances.