Differential Diagnosis of Membranoproliferative Glomerulonephritis

• There are many different kinds of kidney diseases and many of them are similar in some aspects, so it is necessary to distinguish them from each other. For Membranoproliferative Glomerulonephritis (MPGN), the differential diagnosis should exclude all the secondary factors such as Hepatitis B or C, other infections of AIDS or Connective Tissue Disease (CTD).

  Diagnosis of MPGN is mainly through histopathological examination. Along with the gradual prevalence of Hepatitis C, HIV or CTD -associated MPGN, patients who seem to have primary MPGN must conduct corresponding serologic examination.

  The most common diseases that should be differentiated with MPGN are as follows:

  1. Diabetic Nephropathy. Nodositas damage of MPGN appears in most of the glomeruli, while in Diabetic Nephropathy, there are less glomeruli which have this damage. In addition, these two diseases can be differentiated with immunopathological methods.

  2. Amyloidosis Nephropathy. It can be differentiated with MPGN through HE Congo red stain and by electron microscopic examination.

  3. Light Chain Nephritis. It is difficult to distinguish from MPGN by light microscopy, but can be explicitly identified by immunopathology.

  4. Lupus Nephritis. Chronic Hypocomplementemia (MPGN is once called Hypocomplementemia) should be differentiated with Lupus Nephritis, which can have different kinds of pathological changes such as MPGN-like changes. However, Lupus Nephritis can have deposition of IgG,IgM, IgA, C3, C4, C1q,etc., while in MPGN, the simultaneous occurrence of different kinds of immune globulins and complements is rare.

  5. Henoch-Schonlein Purpura Nephritis (or Anaphylactoid Purpura Nephritis). This disease can have pathological changes similar to that of MPGN. Focal point of the differentiation is large amount of IgA deposition in glomerular mesangial area and loop of the capillary in Lupus Nephritis. In addition, there can be such manifestations as skin purpura, arthralgia and abdominal pain, etc.

  6. Post-infection Nephritis. It is sometimes difficult to be identified from Type I MPGN, but it usually has shorter course of disease. Occasionally, Post-infection Nephritis can develop into MPGN.

  Diagnosis of MPGN should be differentiated with the above-mentioned diseases. A correct and early diagnosis of it will be helpful to its treatment. 

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• Diagnosis and Tests of Membranoproliferative Glomerulonephritis