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Mesangial Proliferative Glomerulonephritis

This accounts for approximately 5% of idiopathic nephrotic syndrome. It is common in older children and young adults. Causes of Membranoproliferative (Mesangiocapillary) Glomerulonephritis (MPGN)



Type I  With subendothelial and mesangial immune deposits


Type II With intramembranous dense deposits containing sparse or no Ig; associated with C3 nephritic factor

Type III Features of type I MPGN and membranous nephropathy

In association with systemic diseases or drugs


Systemic immune – complex disease          SLE, mixed cryoglobulinemia, Sjögren’s syndrome


Chronic infections                                       Hepatitis B and C, HIV, bacterial endocarditis,


Malignancy                                                 Leukemias, lymphomas


They present with microscopic to gross hematuria and selective or non – selective proteinuria depending on the severity of the disease.

Some patients are steroid – responsive and have a benign course.


Other patients who are steroid – non responsive have a poor prognosis, developing renal failure 5 – 10 years after diagnosis.


Focal and Segmental Glomerulosclerosis


This accounts for about 10 – 15% of idiopathic nephrotic syndrome.


It is more commonly seen in adults in the age group of 20 – 30 years.


Etiology of Focal and Segmental Glomerulosclerosis

  1. Idiopathic (majority)
  2. In associated with systemic diseases or drugs
    1. HIV infection                
    2. Diabetes mellitus 
  3. As consequence of sustained glomerular capillary hypertension
    1. Congenital oligo nephropathies          
    2. Unilateral renal agenesis
    3. Reflux nephropathy                  
    4. Glomerulonephritis or tubulointerstitial nephritis
    5. Sickle cell nephropathy                    
    6. Heroin use 


  1. Proteinuria is present and is usually nonselective.
  2. Hypertension, reduced GFR, abnormal tubular function and abnormal urinary sediments (leukocyturia, hematuria) are seen.
  3. Hyperlipidemia is severe in cases with focal sclerosis.

Prognosis is variable. In steroid responsive patients, prognosis is good, but in steroid unresponsive patients and in patients with heavy proteinuria rapid progression to end stage renal failure occurs within a few months. Cyclosporine, as an adjunctive therapy to steroids, may be beneficial in some cases.

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