Membranoproliferative glomerulonephritis causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3] Nazia Fuad M.D.

Overview

The most common causes for membranoproliferative glomerulonephritis autoimmune diseases, mainly systemic lupus erythematosus (SLE), Sjögren syndrome, rheumatoid arthritis, inherited complement deficiencies (esp C2 deficiency), scleroderma, Celiac disease .Chronic infections also play major role such as viral infections like hepatitis B, hepatitis C, and cryoglobulinemia type II, bacterial infections such as endocarditis, infected ventriculoatrial (or jugular) shunt, multiple visceral abscesses, leprosy. Protozoal – malaria, schistosomiasis. Rare causes of MPGN include non-Hodgkin lymphoma, renal cell carcinoma, snake venom, splenorenal shunt surgery for portal hypertension , melanoma, alpha-1-antitrypsin deficiency, and cryoglobulinemic glomerulonephritis and Idiopathic MPGN .

Causes

Life- threatening Causes

There are no life-threatening causes of membranoproliferative glomerulonephritis. , however complications resulting from untreated membranoproliferative glomerulonephritis are common.

Common Causes

Common causes of MPGN may include:^[1]^[2]^[3]

Immune complex–mediated disease

Autoimmune diseases
- Systemic lupus ery thematosus (SLE)
- Sjögren syndrome

Chronic infections
- Viral – Hepatitis B, hepatitis C, and cryoglobulinemia type II
- Bacterial – Endocarditis, infected ventriculoatrial (or jugular) shunt, multiple visceral abscesses, leprosy
- Protozoal – Malaria , schistosomiasis
- Other infections – Mycoplasma, Lyme Disease^[4]
Miscellaneous – Chronic liver disease (cirrhosis and alpha1-antitrypsin deficiency)

Chronic and recovered thrombotic microangiopathies

Healing phase of hemolytic uremic syndrome and/or thrombotic thrombocytopenic purpura
Syndromes of circulating antiphospholipid (anticardiolipin) antibodies
Radiation nephritis
Nephropathy associated with bone marrow transplantation
Sickle cell anemia and polycythemia
Transplant glomerulopathy

Malignant neoplasms

Less Common Causes

Less common causes of MPGN include

Idiopathic forms of MPGN or of unknown association^[5]

- MPGN type I
- MPGN type II or dense deposit disease.
- MPGN type III
Paraprotein deposition diseases

- Glomerulonephropathies associated with cryoglobulinemia type I
- Waldenström macroglobulinemia
- Immunotactoid glomerulopathy
- Immunoglobulin light chain or heavy chain deposition diseases
- Fibrillary glomerulonephritis
Non-Hodgkin lymphoma
Renal cell carcinoma
Snake venom
Splenorenal shunt surgery for portal hypertension
Melanoma
Alpha-1-antitrypsin deficiency
Inherited complement deficiencies, specially C2 deficiency

Genetic Causes

MPGN is caused by a mutation in the complement factor H-related protein 5 (CFHR5) gene.

Causes by Organ System

Cardiovascular	Endocarditis, infected ventriculoatrial (or jugular) shunt
Chemical/Poisoning	Snake venom
Dental	No underlying causes
Dermatologic	Melanoma, Leprosy
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Celiac disease, hepatitis B and C, chronic liver disease Splenorenal shunt surgery for portal hypertension Alpha-1-antitrypsin deficiency
Genetic	(CFHR5) gene mutation, Alpha-1-antitrypsin deficiency
Hematologic	Sickle cell anemia, polycythemia and non-hodgkin lymphoma, cryoglobulinemia, Lymphoma Leukemia Hemolytic uremic syndrome
Iatrogenic	No underlying causes
Infectious Disease	Viral – hepatitis B, hepatitis C, and cryoglobulinemia type II Bacterial – endocarditis, infected ventriculoatrial (or jugular) shunt, multiple visceral abscesses, leprosy Protozoal – malaria , schistosomiasis Other infections – mycoplasma, lyme Disease
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Leprosy
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Lymphoma, leukemia, carcinoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Mycoplasma pneumonia, alpha-1-antitrypsin deficiency
Renal/Electrolyte	Rnal cell carcinoma Hemolytic uremic syndrome Radiation nephritis Nephropathy associated with bone marrow transplantation Transplant glomerulopathy
Rheumatology/Immunology/Allergy	Systemic lupus ery thematosus (SLE) Sjögren syndrome Rheumatoid arthrit is Scleroderma Celia c disease Immunoglobulin light chain or heavy chain deposition diseases
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Hemolytic uremic syndrome
Miscellaneous	Chronic liver disease (cirrhosis and alpha1-antitrypsin deficiency)

References

↑ H. Terence Cook and Matthew C. Pickering (2014). “Histopathology of MPGN and C3 glomerulopathies”. NATURE REVIEWS NEPHROLOGY.
↑ MICHELINE LEVY, MARIE-CLAIRE GUBLER, MIREILLE SICH, AGNES BEZIAU, AND RENE HABIB (1978). “lmmunopathology Glomerulonephritis of Membranoproliferative with Subendothelial Deposits”. clinical immunology and immunopathology.
↑ Mårten Segelmark, Thomas Hellmark (2010). “Autoimmune kidney diseases”. Elsevier.
↑ Dimitrios Kirmizis, MD, Georgios Efstratiadis, MD, Dominiki Economidou, MD, Evdoxia Diza-Mataftsi, MD, Maria Leontsini, MD, and Dimitrios Memmos, MD (2004). “MPGN Secondary to Lyme Disease”. American Journal of Kidney Diseases. 43.
↑ Fernando C. Fervenza, Sanjeev Sethi, and Richard J. Glassock (2012). “Idiopathic membranoproliferative glomerulonephritis: does it exist?”. Nephrology Dialysis Transplantation ( NDT ).

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[1] H. Terence Cook and Matthew C. Pickering (2014). “Histopathology of MPGN and C3 glomerulopathies”. NATURE REVIEWS NEPHROLOGY.

[2] MICHELINE LEVY, MARIE-CLAIRE GUBLER, MIREILLE SICH, AGNES BEZIAU, AND RENE HABIB (1978). “lmmunopathology Glomerulonephritis of Membranoproliferative with Subendothelial Deposits”. clinical immunology and immunopathology.

[3] Mårten Segelmark, Thomas Hellmark (2010). “Autoimmune kidney diseases”. Elsevier.

[4] Dimitrios Kirmizis, MD, Georgios Efstratiadis, MD, Dominiki Economidou, MD, Evdoxia Diza-Mataftsi, MD, Maria Leontsini, MD, and Dimitrios Memmos, MD (2004). “MPGN Secondary to Lyme Disease”. American Journal of Kidney Diseases. 43.

[5] Fernando C. Fervenza, Sanjeev Sethi, and Richard J. Glassock (2012). “Idiopathic membranoproliferative glomerulonephritis: does it exist?”. Nephrology Dialysis Transplantation ( NDT ).

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