Abstract
The prevalence of membranoproliferative glomerulonephritis (MPGN) is very low among primary glomerulonephritis. Once MPGN is diagnosed, it is essential to classify the type of MPGN [immune complex (IC), complement-mediated, and without complement or IC deposition]. In cases of IC-MPGN, secondary causes should be thoroughly investigated. However, there are no randomised controlled prospective trials for the optimal treatment regime for primary IC-MPGN. Here, we present a report of primary IC-MPGN that achieved partial remission after 3 years of mycophenolate mofetil treatment, even though significant fibrosis was present in the kidney biopsy. This report may support consideration of prolonged immunosuppression in selected cases with primary IC-MPGN.
References
1. AlYousef A, AlSahow A, AlHelal B, Alqallaf A, Abdallah E, Abdellatif M, Nawar H, Elmahalawy R. Glomerulonephritis Histopathological Pattern Change. BMC Nephrol. 2020: 186 [PMID: 32423387, https://doi.org/10.1186/s12882-020-01836-3]
2. Maifata S, Hod R, Ghani FA, Zakaria F. Prevalence and Pattern of Glomerulonephritis: An Experience of Two Tertiary Centers in Malaysia. Saudi J Kidney Dis Transpl. 2023: 167 [PMID: 38146727, https://doi.org/10.4103/1319-2442.391896]
3. Bernardes TP, Mastroianni-Kirsztajn G. Membranoproliferative glomerulonephritis: current histopathological classification, clinical profile, and kidney outcomes. J Bras Nefrol. 2023: 45 [PMID: 35789244, https://doi.org/10.1590/2175-8239-JBN-2022-0016en]
4. Najafian B, Lusco MA, Alpers CE, Fogo AB. Approach to Kidney Biopsy: Core Curriculum 2022. Am J Kidney Dis. 2022: 119 [PMID: 35125261, https://doi.org/10.1053/j.ajkd.2021.08.024]
5. Nugent JP, Bissonnette MLZ, Gibney B, Farah M, Harris AC. Nontargeted Native Renal Biopsy Adequacy: Preintervention Data From a Province-Wide, Multicentre, and Interdepartmental Audit. Can J Kidney Health Dis. 2023: 20543581231205161 [PMID: 37841342, https://doi.org/10.1177/20543581231205161]
6. Fervenza FCaS, S. Membranoproliferative glomerulonephritis: Treatment and prognosis: UpToDate.com; 2025. Available from: https://www.uptodate.com/contents/membranoproliferative-glomerulonephritis-treatment-and-prognosis.
7. Kidney Disease: Improving Global Outcomes Glomerular Diseases Work G. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021: S1 [PMID: 34556256, https://doi.org/10.1016/j.kint.2021.05.021]
8. Kim S, Choi YE, Kim SG, Ryu DR, Park SH, Koo TY, Kim MG, Jo SK, Oh SW. Clinical features and outcomes of immune complex-membranoproliferative glomerulonephritis and C3 glomerulopathy: a multicenter observational cohort study analyzing kidney biopsy cases. Kidney Res Clin Pract. 2024: [PMID: 39980095, https://doi.org/10.23876/j.krcp.24.129]
9. Nakagawa N, Mizuno M, Kato S, Maruyama S, Sato H, Nakaya I, Sugiyama H, Fujimoto S, Miura K, Matsumura C, Gotoh Y, Suzuki H, Kuroki A, Yoshino A, Nakatani S, Hiromura K, Yamamoto R, Yokoyama H, Narita I, Isaka Y. Demographic, clinical characteristics and treatment outcomes of immune-complex membranoproliferative glomerulonephritis and C3 glomerulonephritis in Japan: A retrospective analysis of data from the Japan Renal Biopsy Registry. PLoS One. 2021: e0257397 [PMID: 34520493, https://doi.org/10.1371/journal.pone.0257397]
10. Elahi T, Ahmed S, Ahmed E, Mubarak M. Clinicopathological characteristics and outcomes of adult patients with idiopathic membranoproliferative glomerulonephritis according to an immunofluorescence-based classification. J Nephrol. 2024: 2255 [PMID: 39400860, https://doi.org/10.1007/s40620-024-02083-7]
11. Noris M, Daina E, Remuzzi G. Membranoproliferative glomerulonephritis: no longer the same disease and may need very different treatment. Nephrol Dial Transplant. 2023: 283 [PMID: 34596686, https://doi.org/10.1093/ndt/gfab281]
12. Noris M, Remuzzi G. C3G and Ig-MPGN-treatment standard. Nephrol Dial Transplant. 2024: 202 [PMID: 37604793, https://doi.org/10.1093/ndt/gfad182]
13. Bomback AS, Charu V, Fakhouri F. Challenges in the Diagnosis and Management of Immune Complex-Mediated Membranoproliferative Glomerulonephritis and Complement 3 Glomerulopathy. Kidney Int Rep. 2025: 17 [PMID: 39810761, https://doi.org/10.1016/j.ekir.2024.09.017]
14. Hogan MC, Reich HN, Nelson PJ, Adler SG, Cattran DC, Appel GB, Gipson DS, Kretzler M, Troost JP, Lieske JC. The relatively poor correlation between random and 24-hour urine protein excretion in patients with biopsy-proven glomerular diseases. Kidney Int. 2016: 1080 [PMID: 27528553, https://doi.org/10.1016/j.kint.2016.06.020]
15. Charlesworth JA, Gracey DM, Pussell BA. Adult nephrotic syndrome: non-specific strategies for treatment. Nephrology (Carlton). 2008: 45 [PMID: 18199102, https://doi.org/10.1111/j.1440-1797.2007.00890.x]
16. Semenikhina M, Mathew RO, Barakat M, Van Beusecum JP, Ilatovskaya DV, Palygin O. Blood Pressure Management Strategies and Podocyte Health. Am J Hypertens. 2025: 85 [PMID: 39269328, https://doi.org/10.1093/ajh/hpae120]
17. Mhmndar MA, Singh T, Fatima I, Shehryar A, Zaidi MR, Mairaj M, Khan SM, Kolanu ND, Ahmed S, Kamal A, Rehman A, Quinn M. Comparative Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers in Hypertensive Patients With Chronic Kidney Disease: A Systematic Review. Cureus. 2025: e78845 [PMID: 40084336, https://doi.org/10.7759/cureus.78845]
18. Tada K, Nakano Y, Takahashi K, Hiyamuta H, Watanabe M, Ito K, Yasuno T, Abe M, Satoh A, Kawazoe M, Maeda T, Yoshimura C, Kosuke M, Arima H. Current use of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors for hypertension in patients with chronic kidney disease with proteinuria: a cross-sectional study based on real-world data. Hypertens Res. 2025: 244 [PMID: 39300299, https://doi.org/10.1038/s41440-024-01896-0]

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