What is the first line treatment for Membranoproliferative glomerulonephritis?
Children who are clinically well and free of symptoms or only have minor urinary abnormalities generally do not require aggressive therapy.
These patients may be treated with antihypertensive agents, specifically an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), to reduce proteinuria and prevent progressive kidney damage.
Those with more severe disease are treated with prolonged alternate-day therapy with oral steroids, prednisone 40 to 60 mg/m 2 , or 2 to 2.5 mg/kg every other day for an average period of 6.5 years, leading to an improved outcome compared with historic controls or patients treated at other centers.
Repeat biopsies performed after 2 years of therapy have shown an increase in open capillary loops and a reduction in mesangial matrix expansion, suggesting that there may be an increase in glomerulosclerosis despite clinical improvement.
The efficacy of therapy was greater in patients who began treatment within 1 year of disease onset and in those whose GFR was well preserved (i.e., >70 mL/min per 1.73 m 2 ).
In adults, there is widespread concern about the risks of prolonged steroid therapy.
Therefore the current evidence-based medicine recommendation is to prescribe steroids only for adults with nephrotic syndrome or impaired kidney function. Treatment is maintained for 6 months.
Patients with asymptomatic urinary findings or who fail to respond to steroids should be treated conservatively.
ACEIs have been demonstrated to be effective in reducing proteinuria in patients with MPGN. Combined therapy with dipyridamole, cyclophosphamide, and warfarin does not appear to be beneficial, and this treatment is no longer recommended.
In patients with hepatitis C infection and Membranoproliferative glomerulonephritis, several new antiviral agents (e.g., boceprevir, telaprevir, simeprevir, sofobuvir, and the ledipasvir-sofobuvir combination) have been introduced into clinical practice.
They have led to dramatically improved viral clearance and outcomes.
However, the impact of these agents on the incidence of hepatitis C–related Membranoproliferative glomerulonephritis has not been assessed.
