Diagnosis and Tests of Membranoproliferative Glomerulonephritis

• Clinically, patients should be highly suspected as suffering from Membranoproliferative Glomerulonephritis(MPGS), when proteinuria or Nephrotic Syndrome with hematuria, persistent Pypocoplementemia, and anemia which is not accordant with the degree of renal insufficiency, occur to patients. However, as the clinical manifestations of MPGN lack specificity, the clinical diagnosis is often not reliable. MPGN should be diagnosed mainly by biopsy.

  I. Laboratory test

  1. The test of urine

  The urine is often abnormal. Hematuria can be seen by microscopic examination, which often presents as microscopic hematuria, and its occurrence usually is 70%~90%. The urine protein is often nonselective.

  2. The test of blood

  By the test of blood, it is found that anemia often occurs to patients with MPGS, and the severity of anemia is disproportionate with that of the damages of renal functions. At the early stage of MPGS, the renal function of most patients is normal, and the glomerular filtration rate decreases only in few patients.

  II. Assistant tests

  1. Light microscope

  The diffuse proliferation of mesangial cells is the basic pathological characteristic, with the broadening of mesangial area possibly. This lesion often can affect 80% of the glomeruli, and the lesion severity of most glomeruli is similar, and therefore, it is known as diffuse proliferaton. At the early stage, the diffuse proliferation mainly presents as the increase of mesangial cells; in the moderate lesions, the number of mesangial cells increases to 4~5 in each mesangial area; while in severe lesions, the number is over 5 in each mesangial area, and the infiltration of mononuclear cells can be seen in mesangial area.

  2. Electron microscope

  Deposits of electron-dense material can be seen in over 50% of the mesangial area by biopsy, but the components are not clear yet. Slight change of basilar membrane is common, such as the thickening or irregularity of basilar membrane.

  3. Immunofluorescence

  By immunofluorescence, four kinds of manifestations can be seen:

  ◆ Deposit of immunoglobulin highlighted IgM with or without C3, and deposit of IgM is common in mesangial area.

  ◆ Deposits of IgG and C3 occur to 58% of the patients with MPGS.

  ◆ There is only deposit of complement C3.

  ◆ There is no deposits, and the immune pathologic infection is negative.

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• Differential Diagnosis of Membranoproliferative Glomerulonephritis