CLINICAL PROFILE AND TREATMENT OUTCOMES OF IMMUNE-COMPLEX MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS AND C3 GLOMERULONEPHRITIS IN A TERTIARY CARE CENTER

Introduction:

Membranoproliferative glomerulonephritis, a slowly progressive glomerular disease with distinct morphologic pattern in renal biopsy. A rare cause of ESKD, with declining incidence, still relevant in LMICs. Last few decades MPGN classification had seen changes. Epidemiology and outcome are underreported in our population. Here we provide clinical profile and treatment outcome of IC-MPGN and C3GN in our population.

Methods:

This observational analytical study, done in a tertiary care hospital of Kolkata. Patients included with biopsy proven MPGN, between January 2022 to July 2024, with minimum f/u of 12 months excluding Secondary MPGN- lupus nephritis, infectious diseases like hepatitis B, hepatitis C and shunt infection, MGRS, IgA nephropathy. No prespecified sample size was there. Primary outcome was to compare renal survival (50% rise in serum Cr from baseline, ESKD) in between IC- MPGN and C3 GN. Secondary outcomes were comparison of proteinuria reduction rate and impact of therapy on decline in renal function or ESKD in between two groups.

Results:

24 patients included,11 were IC-MPGN (45.8%) and 13 were C3GN (54.2%). Median f/u period-15 and 12 months for IC MPGN and C3 GN respectively. No age and gender predilection in between IC-MPGN and C3 GN. At 1st visit, 45.5% of IC-MPGN and 46.2% of C3GN had nephrotic syndrome, 36.4% in IC MPGN and 30.8% in C3GN had nephritic syndrome, 18.1% in IC-MPGN and 23.0% in C3GN had RPRF. No patient had chronic GN. eGFR difference at 1st presentation was nonsignificant. Mean C3 level was 68.2 and 85.9 mg/dl in C3GN and IC MPGN respectively. In biopsy, all patients had endocapillary proliferation but 53.8% of C3GN and 36.4% of IC-MPGN had crescents. Most patients had IFTA < 25% (90.9% in IC MPGN vs 76.9% in C3 GN group). More patients in IC MPGN received conservative therapy (45.5% in IC MPGN vs 7.7% in C3 GN, p= 0.033). Majority in C3 GN received immunosuppression( steroid only/ steroid with MMF/cyclophosphamide (92.3% vs 54.5%, p= 0.023). At last f/u, significant number of patients in IC- MPGN achieved remission (54.5% vs 0%, p= 0.003).at last f/u C3 GN group had significant hematuria (53.8% vs 9.1%, p=0.033), low eGFR (24.1 vs 85.3 ml/kg, p=0.015),low serum albumin (2.9 vs 4.2 gm/dl). 23.1% patient in C3 GN group developed ESKD but no patients in IC- MPGN group developed ESKD.3 patients in C3 GN & 1 patient in IC MPGN died during f/u. Using Kaplan Meier survival curves- renal survival (50% rise of creatinine from base line and ESKD) compared between IC MPGN and C3 GN. No significant difference seen in renal survival between IC MPGN and C3 GN. Regarding reduction in proteinuria <1 gm/day, IC MPGN had significant survival chance in comparison to C3 GN. No significant beneficial impact of immunosuppression over renal survival in between IC MPGN and C3 GN. variables at 1st visit like age(per year), gender, SBP, proteinuria, serum albumin, eGFR and initial therapy assessed with cox proportional hazards model. In univariate analysis age (per year), proteinuria, serum albumin had influence in 50% rise of creatinine. But in multivariate analysis they lost their significance. no variables show significant influence in renal survival in terms of ESKD.

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Conclusions:

Prognosis of IC MPGN more favorable than C3 GN. IS was not showing benefit in both groups in terms of proteinuria reduction and renal survival. Study with larger sample with more insight in disease pathophysiology needed for better outcome.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.