Case Reports A Newer Approach to the Management of Membrano Proliferative Glomerulonephritis – Experience from A Tertiary Level Hospital, Bangladesh

1. Professor Md. Habibur Rahman, Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka Cell: 01711381693, 2. Dr. Tahmina Jesmin, MD Resident (Phase B), Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. 2. Dr. Afroza Begum, Associate Professor of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. 3. Prof. Goalm Muinuddin, Professor of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Correspondence: Prof. Md. Habibur Rahman, Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh, Cell: 01711381693, Email: [email protected] Introduction: Idiopathic Nephrotic Syndrome (INS) is regarded as proteinuria, hypoalbuminemia, generalized oedema and hyper lipidemia1. Minimal change disease (MCD) is the commonest (76.6%) histological variant of INS and 90% of them respond with adequate dose of steroid which have normal renal function over the long term2,3. Though 3-5% cases of MCD is responsive to steroid initially, but subsequently becomes resistant4. Approximately 10% INS are steroid resistant4. In the landmark study by International Study of Kidney Diseases in Children (ISKDC); MCD (Minimal Change Disease), FSGS (Focal segmental glomerulous Sclerosis) and MPGN (Membrano Proliferative Glomerulonephritis) each are accounted for about a quarter of children with steroid resistant nephrotic syndrome2. Though they are associated with atypical clinical and laboratory findings like hypertension, hematuria, renal insufficiency, low complement level etc with significant glomerular lesion; but during initial episodes, other histological variant of INS may not give any clinical and laboratory clue regarding histological variant. Usually these cases are referred to Pediatric Nephrologist after 4 weeks of steroid therapy, where as the case deserves much earlier attention. The treatment of patients with histological variant other than MCD is more complicated5. Till now, no ideal regimen has been identified to treat such type of INS. Different authors have been trying with different regimens and number of medications such as methyl prednisolone, cyclophosphamide, cyclosporine, mycophenolate mofetil with varying results. Recent reports have showed remission rates ranging from 20 to 70% by using these drugs6. But, these drugs are associated with various complications and ultimately progress to end stage renal disease6.