Membranoproliferative glomerulonephritis (MPGN)

Overview

Membranoproliferative glomerulonephritis (MPGN)

Membranoproliferative glomerulonephritis (MPGN) causes inflammation (swelling) in the kidneys. Children with MPGN have blood and protein in their urine, and may have swelling in their body, especially around their face and legs. MPGN may lead to other complications, including high blood pressure (hypertension). Some children need to stay in hospital and/or take medicines. All children are carefully monitored by a team of healthcare professionals, and will need to go back to the hospital clinic for follow-up appointments.

About the urinary system 

The urinary system gets rid of things that the body no longer needs, so that we can grow and stay healthy.

  • The kidneys are bean-shaped organs. They filter blood to remove extra water and waste in urine (wee). Most of us have two kidneys. They are at the back on either side of our spine (backbone), near the bottom edge of our ribs.
  • The two ureters are long tubes that carry urine from the kidneys to the bladder.
  • The bladder is a bag that stores urine until we are ready to urinate (have a wee). It sits low down in the tummy area.
  • The urethra is a tube that carries urine from the bladder to the outside of the body.

About MPGN

About glomerulonephritis

Membranoproliferative glomerulonephritis (MPGN) is a type of glomerulonephritis, a group of conditions that affect the kidneys. Inside the kidneys, there are many tiny filters called glomeruli. They help to remove extra water, salt and waste, which are passed out of the body as urine. They also make sure the body keeps what it needs, such as blood cells, protein and other important chemicals.

In glomerulonephritis, the glomeruli become inflamed (swollen) or damaged. This causes both blood and protein to leak into the urine.

About MPGN

In MPGN, a protein called complement is deposited, or put, on the glomeruli. MPGN is also called mesangiocapillary glomerulonephritis (MCGN). We will refer to the condition as MPGN throughout this topic.

Symptoms and complications

Symptoms and signs

Some children with MPGN do not have any symptoms and signs, especially in the early stages of the disease. Common symptoms and signs include:

  • blood in the urine (haematuria) – you cannot always see the blood, but if there is a lot, the urine may be coloured red or dark brown (like a cola drink)
  • protein in the urine (proteinuria) – you cannot usually see the protein, but sometimes it can make the urine look frothy. It can be found on a simple urine test
  • urinating less often or smaller amounts
  • swelling or puffiness in different parts of the body, especially around the eyes, legs and feet – this is called oedema
  • rarely, swelling in the abdomen (tummy), or breathlessness.

Complications

Some children have complications – health problems that happen because of the condition – including those below.

  • MPGN may lead to blood pressure that is too high (hypertension).
  • Occasionally, the condition gets worse quickly and the kidneys work less well than normal – this is called rapidly progressive glomerulonephritis (RPGN).
  • RPGN is one cause of acute kidney injury (AKI) – when the kidneys quickly stop working as well as they should, over a short time.

More about symptoms and complications

Causes

MPGN can happen in people of all ages, though it is more common in people under 30, especially children. It often starts in older children or teenagers. MPGN can sometimes happen after an infection. It is usually caused by problems with the immune system, which normally protects the body against disease and infection.

Types of MPGN

There are three types of MPGN – type 1, type 2 (which is also called dense deposit disease, or DDD) and type 3. These different types are identified by looking at the pattern of complement in the glomeruli, and where it is in the walls of the blood vessels that make up the glomeruli.

More about causes

Tests and diagnosis

Diagnosing glomerulonephritis

Your child’s doctor can diagnose (identify) glomerulonephritis by doing some tests. If your child has certain symptoms or signs, such as red or brown urine, your doctor may arrange a urine test. Your doctor will speak with you and your child about the symptoms and do a physical examination. Your child may also need other tests, such as blood tests and an ultrasound scan.

Diagnosing MPGN

Your doctor can diagnose MPGN with a kidney biopsy, and may recommend this test. A tiny piece of one kidney is removed from the body with a needle, and examined under microscopes. Special medicines are used so your child does not feel any pain or can sleep through the procedure.

More about tests and diagnosis

Treatment

Where will my child be treated?

Your child will probably be admitted to hospital for a few days or longer, to be carefully monitored by a team of healthcare professionals. This is usually in a paediatric renal unit, a special unit for children with kidney problems, which may be in a different hospital to your own. Your child will be looked after by a paediatric nephrologist, a doctor who treats children with kidney problems.

About treatment

The healthcare team will check how your child’s kidneys are working, test how much he or she is weeing, and measure his or her blood pressure. They will support you and your family throughout the treatment. Your child can go home when the doctor thinks that his or her health is stable. Your child will need to go back to the hospital clinic for treatment or follow-up.

Some children need to take medicines for a few weeks or longer. These include steroids, which slow down the immune system to stop it harming their kidneys, and other medicines to help treat swelling in their body or control blood pressure. If another health condition is causing MPGN, this may need special treatment too.

What happens if my child does not get better?

If your child’s kidneys stop working properly, he or she may need special treatment. This may include dialysis, which uses special machines to do the job of healthy kidneys.

It is important that your child follows any treatment plan outlined by your doctor.

About the future

Follow up

MPGN is a chronic condition, which means that it does not go away quickly, and may last for years. All children with MPGN need follow-up appointments at the hospital or clinic, to check for any health problems.

Long-term effects

Your doctor will speak with you and your child about any long-term effects that MPGN has on your child. Children with type 2 MPGN (dense deposit disease) are more likely to have more serious problems than children with type 1 or type 3 MPGN.

Some children with MPGN may progress to later stages of chronic kidney disease (CKD) – the kidneys stop working as well as they should. Some children with CKD may progess to final stages of CKD (kidney failure). These children may need specialist treatment, including dialysis and/or a kidney transplant.

If your child has progressed to later stages of CKD, you will learn more over time about what to expect and how to help manage the condition.

More about the future

 

Symptoms and complications

Symptoms and signs

Blood in the urine

When red blood cells leak through the kidney’s filters into the urine, this causes haematuria (blood in the urine). Sometimes you cannot see the blood, but if there is a lot, the urine may be coloured red or dark brown (like blackcurrant squash or a cola drink).

Protein in the urine

When proteins leak through the kidney’s filters into the urine, this causes proteinuria (more protein in the urine than normal). You cannot usually see the protein, but occasionally it can make the urine look frothy. Protein is an important part of our diet and is in most foods. When we eat protein, it is digested (broken down) in the stomach and gut and taken into the blood.

Problems urinating

Some children urinate less often or pass smaller amounts.

Swelling

Some children have swelling or puffiness in different parts of their body, especially around their eyes, legs and feet (oedema).

Swelling in the tummy and breathlessness

  • A few children get a large swelling around their tummy (ascites). It happens when fluid builds up in the peritoneal cavity, which is the area around the organs in the abdomen (tummy).
  • A very small number of children feel breathless. This happens when fluid builds up around their lungs.

If your child has MPGN and a very swollen tummy or feels breathless, contact your doctor as soon as possible.

Other symptoms and signs

The below are occasionally found in children with MPGN:

  • feeling tired, low energy or difficulty concentrating
  • decreased appetite (not wanting to eat)
  • nausea (feeling sick) or vomiting (being sick), or diarrhoea
  • pain in the tummy
  • headaches that keep coming back or that do not go away
  • pain, stiffness or swelling of the joints.

Complications

Some children have more complications – health problems that happen because of the condition or its treatment. These are more rare. Your child’s healthcare team will carefully check for these, and speak with you about any treatment that your child may need.

High blood pressure

MPGN can cause blood pressure that is too high (hypertension). In some children, this causes headaches, vomiting or blurred (fuzzy) vision. Hypertension that lasts a long time can also increase the risk of getting other diseases in adulthood.

Risk of infections

Some children with MPGN are treated with medicines that suppress, or damp down, their immune system, which normally protects the body from infections. These children are more likely to get infections.

Rapidly progressive glomerulonephritis

Occasionally, MPGN gets worse quickly – this is called rapidly progressive glomerulonephritis (RPGN) or crescentic glomerulonephritis. If this happens, your child will need to take medicines and may need more intensive treatment, such as dialysis. Some children with RPGN will get better, but a few will need long-term dialysis before they can have a kidney transplant.

This is one cause of acute kidney injury – when the kidney quickly stop working as well as they should, over a short time.

Symptoms and complications

 
There are two reasons why children with MPGN get oedema.
 
  • Sometimes, the damaged kidney filters (glomeruli) are not able to filter enough salt and water out of the blood into urine. After a while, there is too much salt and water in the body, which causes the swelling.
 
  • Sometimes, the kidneys leak a large amount of protein, especially a type called albumin, into the urine. This leads to nephrotic syndrome. Fluid moves in and out of the bloodstream to nourish (feed) the body’s cells. Albumin helps keep fluid in the bloodstream – if there is not enough albumin, fluid stays outside the bloodstream and in parts of the body. This causes the swelling.

 

 

Causes

What happens in the kidneys

In MPGN, a protein called complement gets trapped in the tiny kidney filters (glomeruli). Complement is part of the immune system, which normally protects the body from infection and disease. Doctors think that the complement in the glomeruli is causing the MPGN.

The immune system

Many germs – including bacteria and viruses – can make us sick if they get into the body. The immune system can kill these germs. However, if the immune system is not working properly, it can start to cause problems.

Germs

The immune system protects the body against germs such as bacteria and viruses that can cause illness. These germs can enter the body in lots of ways, such as by the nose and throat or the urinary system. If we get a cold or flu, this means that a virus germ has got into the body and started to infect some of our body’s cells. Germs have special ‘markers’ that are different from the markers on our own body’s cells. This means that the immune system can recognise that they are germs and kill them. We often feel sick for a few days or a few weeks while this is happening.

Parts of the immune system

The immune system has many different ways to protect the body against disease. Some of the parts include those listed below.

  • White blood cells are living cells in the blood. Often, the number of white blood cells found in a blood test can give information about someone’s immune system. The two main types of white blood cells in the immune system are neutrophils and lymphocytes.
  • Antibodies or immunoglobulins recognise the germs that have come into the body, and can bind (stick) to them. There are five types: immunoglobulin A (IgA), immunoglobulin D (IgD), immunoglobulin E (IgE), immunoglobulin G (IgG) and immunoglobulin M (IgM).
  • The complement system is made up of other proteins that float in the blood. These proteins work with (complement) other parts of the immune system to help kill germs or cells infected by germs. Normally, the body controls when complement is activated, so it does not attack the body itself.

When the immune system does not work properly

Sometimes the immune system does not work as expected and can cause problems. For example, sometimes the immune system cannot recognise the body’s own cells and may attack them as if they were invaders like germs.

Types of MPGN

There are three types of MPGN. These are identified by the pattern of complement that is trapped in the glomeruli.

  • Type 1 and type 3 are very similar.
  • Type 2 is different. It also called dense deposit disease (DDD) because there are dense (thick) deposits of complement trapped in the glomeruli.

The complement system is made up of proteins that work with other parts of the immune system. It is normally only activated (made to work) when it is needed. This happens in different ways.

Type 1 and type 3 MPGN

Complement can be activated by antibodies (or immunoglobulins), which the body makes to fight specific germs. The antibodies can direct the complement to work against these germs.

Children with type 1 and type 3 MPGN often have both antibodies and complement deposited in their glomeruli. Doctors think that these antibodies are made to fight an infection and that they activate the complement.

Some of these children may also have low levels of one type of complement called C3.

Type 2 MPGN (dense deposit disease)

Children with type 2 MPGN have complement, but no antibodies, deposited in their glomeruli. Doctors think that the complement is activated by itself, which does not normally happen.

Children with type 2 MPGN often have nephritic factors, which are types of autoantibodies. Instead of working against germs, autoantibodies work against the body’s own proteins. These nephritic factors stop a protein called factor H from working. Because factor H normally controls how complement is activated, these autoantibodies allow the complement to become overactive.

Some of these children have low levels of factor H.

Will it affect other family members?

Doctors do not think that MPGN runs in families. If one of your children has this type of glomerulonephritis, it is unlikely that another of your children or another family member will get it.

How the kidney works

Inside each kidney, there are about one million nephrons. Each nephron is made up of a glomerulus (when we talk about more than one glomerulus, we say glomeruli), and a renal tubule.

  • Each glomerulus acts like a sieve, helping to remove extra water and waste from the body, and holding on to blood cells and protein, which the body needs.
  • Blood flows into the kidneys and to each glomerulus.
  • Most of the water and some other substances in the blood pass through the glomeruli
  • This liquid flows into the renal tubule. Most of this liquid moves back into the bloodstream. The rest of it becomes urine.
  • The urine leaves the kidney by the ureters and goes into the bladder, where it is stored until we are ready to go to the toilet.

More about what the kidney does

What happens in MPGN

In MPGN, a protein called complement, which is part of the immune system, gets trapped in the glomeruli. This causes the glomeruli to become inflamed (swollen) or damaged. The damaged glomeruli can let blood cells and protein through, which means they go into the urine.

About the name

Nephritis means inflammation, or swelling, in the kidneys. Glomerulonephritis is specifically about inflammation of the glomeruli.

 

Tests and diagnosis

Your child will need some tests to diagnose (identify) MPGN, find out more about how it is affecting him or her and whether any treatment is needed. Your child may need an examination, urine tests, blood tests, imaging tests and a kidney biopsy.

Examination

Your doctor will talk to you or your child about his or her symptoms and any medicines that he or she takes. The doctor will examine your child – for example, to see whether he or she has oedema (swelling in their body). Your doctor or nurse will check your child’s blood pressure. This is because MPGN may cause high blood pressure (hypertension).

Urine tests

You, or a nurse, will need to collect some of your child’s urine in a small, clean container for a urine test. A dipstick will be dipped into the urine – this is a strip with chemical pads that change colour depending on what substances are in the urine. This shows whether there are blood cells and/or protein, which are signs of MPGN. The sample may also be sent to a laboratory for more accurate tests.

Blood tests

A small amount of blood will be taken from a vein, with a needle and syringe, for a blood test. A special gel or cream can be used to help your child stop feeling any pain. The blood test results can give the doctor more information, including:

  • about the immune system, and whether there has been a recent infection
  • how well his or her kidneys are working – this is called the kidney function
  • the amount of protein in your child’s blood – in MPGN, the kidneys leak protein into urine and this is sometimes enough to affect how much is in the blood.

How well the kidneys are working

A blood test can find out the estimated glomerular filtration rate (eGFR), the amount of fluid that the kidneys filter each minute. A low eGFR means that the kidneys cannot filter as quickly, and so are not working as well as normal.

Infection and immune system

A blood test can check whether there are any antibodies – the body’s immune system makes these special proteins to identify and kill specific germs. This gives information about whether there has been an infection, and sometimes which germ caused it. Antibodies can also cause problems if they get trapped in the glomeruli.

Children with MPGN may have low levels of a protein called complement C3, which is also part of the immune system. This complement works with antibodies to help kill cells infected by germs.

Protein in the blood

Some children with MPGN lose a lot of protein in their urine, when it is leaked through the glomeruli. This means there is less protein in their blood, especially a type of protein called albumin. Because albumin is smaller than other proteins, it is more likely to leak through the glomeruli, the kidney filters.

Imaging tests

Some children need imaging tests (scans). These use special equipment to get images (pictures) of the inside of their body.

  • Ultrasound scan – looks at the shape and size of kidneys and other parts of the urinary system. A small handheld device is moved around your child’s skin and uses sound waves to create an image on a screen.
  • Chest x-ray – for children with breathing problems, this test checks for any fluid (liquid) around the lungs. Your child sits or lies still for a few seconds while a machine takes x-ray images.

Occasionally, other imaging tests are needed.

Kidney biopsy

Your doctor can diagnose MPGN with a kidney biopsy, and may recommend this test. A tiny piece of one kidney is removed from the body with a needle, and examined under microscopes. Special medicines are used so your child does not feel any pain or can sleep through the procedure.

A kidney biopsy can give more information about how much damage there is in your child’s kidney, and confirm whether he or she has MPGN or another type of glomerulonephritis. The kidney biopsy also shows the type of MPGN – type 1, type 2 (dense deposit disease) or type 3. It can take a few weeks to get the results.

 

Treatment

When your child first develops MPGN, he or she probably needs to stay in hospital for a few days to be carefully monitored.

Some children need to take steroid medicines. Some will need other treatment for complications, such as swelling in their body and high blood pressure. These are explained below.

A few children will need dialysis, which uses special equipment to remove waste from the body if their kidneys are not working well enough.

It is important that your child follows any treatment plan outlined by your doctor.

Where will my child be treated?

Your child will probably be referred to a paediatric renal unit, a specialised unit that treats babies, children and young people with kidney conditions and may be in a different hospital to your own. He or she will be looked after by a team, including a paediatric nephrologist, a doctor who treats children with kidney problems.

Outpatient

Your child can go home when the doctor thinks that his or her health is stable. Often, your child will need to visit the hospital during the day – as an outpatient – for check ups or more treatment.

Steroids

Your paediatrician may prescribe a steroid medicine to your child – this is usually the medicine prednisolone. Steroids are chemicals that are made naturally in the body but can also be made as medicines. They suppress the immune system, or make it less active. Your doctor will work out the amount of medicine (the dose) that is right for your child. The dose will be shown on the medicine label. Your child may need to take a large dose each day to start with, and then the dose is slowly reduced. Your doctor will usually monitor blood and urine tests to help decide when to change doses.

It is important that you follow your doctor’s instructions about when and how much to give. Continue to give the medicine to your child as your doctor has told you, even if he or she is getting better.

Hospital visits

A team of healthcare professionals may:

  • check your child’s kidney function (how well his or her kidneys are working)

  • measure how much your child is drinking and how much urine he or she is passing

  • test your child’s urine with a dipstick

  • check your child’s blood pressure.

Healthcare team

Your child’s healthcare team may include:

  • paediatrician – a doctor who treats babies, children and young people

  • paediatric nephrologist – a doctor who treats children with kidney problems

  • radiologist – a healthcare professional who uses imaging tests (scans) to help identify a condition

  • renal nurse – a nurse who cares for children with kidney problems

  • renal dietitian – a healthcare professional who advises what your child should eat and drink during different stages of a kidney condition

  • renal social worker – a professional who supports you and your family, especially with any concerns about

  • money, travel and housing related to looking after your child with kidney disease

  • renal psychologist – a healthcare professional who supports your child and family, especially with emotional stresses and strains from having to look after a child with kidney disease

  • play specialist – a professional who uses dolls and other toys to help your child prepare for procedures, such as blood tests and dialysis

Vaccines

It is important that your child has the vaccines (immunisations) that he or she needs to reduce the risk of some diseases. Speak with your doctor about these – some vaccines are not safe to give while a child is taking steroids.

Infections

Children taking these steroids are more likely to get infections. Speak with your doctor or nurse, and your child’s teacher or daycare manager, about how you can help prevent infection. Contact your doctor straight away if your child:
 
  • has been in contact with someone who has chicken pox (if they have not had this illness before) or measles (if they have not had the MMR vaccine, which protects against measles, mumps and rubella);

or

  • is unwell and you are worried about an infection. If your child does get an infection, he or she may need to take an antibiotic medicine, which kills the germs that cause infection. Your child must take the medicine for the number of days that the doctor has told you, or until all of the medicine has been taken.
If your child does get an infection, he or she may need to take an antibiotic medicine, which kills the germs that cause infection. Your child must take the medicine for the number of days that the doctor has told you, or until all of the medicine has been taken.
 
 
Side-effects you need to do something about We use medicines to help children get better, but sometimes they have effects we do not want – side effects. Contact your doctor straight away if your child has any of the following while on steroid medicines:
  • fever (temperature above 38°C), with a sore throat or a cough
  • a rash or severe bruising
  • bad stomach pain or repeated vomiting – sometimes steroids can cause ulcers in the stomach.

Other side-effects

Other side-effects that affect some children are below – speak with your doctor or nurse if you are concerned or need more support:

  • nausea, vomiting, stomach pain and/or indigestion (heartburn) due to irritation to the lining of the stomach – your doctor may give your child some medicine to treat this
  • behavioural problems – you may find that your child is more likely to have tantrums, be moody, feel depressed, have difficulty sleeping or have nightmares
  • weight gain and larger appetite – you can help by making sure your child has lots of physical activity and eats fruits, vegetables and low-calorie food, rather than food that is high in calories (such as cakes, biscuits, sweets and crisps), and by reducing the portion size
  • high blood pressure (hypertension) – your child’s blood pressure will be regularly checked, and if it is too high, will need to be controlled by adjusting the amount of fluid drunk or taking medicines.

There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor.

Changes to eating and drinking

Your child may need to make temporary changes to what he or she eats – for example, less salt and less of certain foods. He or she may also need to drink less fluid, such as water, squash and soft drinks. Your doctor, nurse or a paediatric dietitian will help you and your child make these changes.

When steroids are needed over a long time, or in high doses, they may have other side-effects. If you have any concerns, talk to your doctor.

  • All steroid medicines, including prednisolone, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery. If your child is unwell and you are worried about an infection, contact your doctor straight away.

  • Steroids can slow growth and affect puberty. They can also cause growth of body hair and irregular periods in girls. Your doctor will check your child’s growth and development.

  • Your child’s skin may become thinner, and heal more slowly than usual. Stretch marks can result from this; it is important to follow instructions about the best amount of fluid to drink to reduce the risk of stretch marks. Acne (spots) may become worse, or your child may develop mouth ulcers or thrush (candidiasis).

  • Your child may develop problems with their hip bones, or their bones may become weaker (osteoporosis). The muscles around their hips and shoulders may also become weaker. If your child has any difficulty walking or moving around, contact your doctor.

  • Occasionally, steroids cause diabetes. If your child seems more thirsty than normal, needs to pass urine (wee) often, or starts wetting the bed at night, contact your doctor.

Controlling blood pressure

Some children with MPGN have high blood pressure (hypertension). If your child has hypertension, he or she may need to change what they eat and drink, and may need medicines, to control the blood pressure.

Reducing protein loss in urine and controlling blood pressure

Some children need to take medicines for:

  • proteinuria – to reduce the amount of protein lost in their urine, and/or
  • hypertension – to reduce or control blood their pressure so it is in the healthy range.

These are usually medicines called angiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin-II receptor blockers (ARBs). Common ACE inhibitors are: captopril, enalapril and lisinopril.

Doctors understand that, in some children, these medicines will reduce the risk of long-term kidney problems.

It is important that you follow your doctor’s instructions about when and how much to give. Do not stop the medicine suddenly.

Reducing swelling in the body – diuretics

Very occasionally, children with MPGN need to take diuretics, medicines that help reduce oedema (swelling in the body). Diuretics work on the kidneys to increase the amount of water and salt they remove from the body in urine.

If your child is taking diuretics, he or she will need to go to follow-up appointments. Your doctor will examine your child for oedema and measure his or her weight. This helps find out how well the medicine is working.

Common diuretics are: furosemide, spironolactone and metolazone. Some of the other diuretics that may be used are: amiloride, bendroflumethiazide and chlorothiazide.

Managing reduced kidney function

For some children, the kidneys do not work as well as normal during this illness – they have reduced kidney function. The severity of this varies, but most do not need any special treatment and their kidney function will return to normal.

A small number will have more serious kidney problems, and will need further treatment. Dialysis uses special equipment or a machine to ‘clean’ the blood, removing waste products and extra water and salts. Most of these children need this treatment for a short time only, but a few need it for longer.

Your child’s healthcare team will give you information to help make sure your child has the best type of dialysis.

Questions to ask the doctor or nurse

  • What treatment does my child need?
  • How will the treatment help my child?
  • How long will my child be in hospital?
  • How can I help my child prepare for procedures and treatments?
  • If the first treatment does not work in my child, what happens next?
  • How will I know if we need to go back to the hospital or see the doctor?
  • Will the MPGN come back? How will I know?

About the future

MPGN is a chronic condition, which means that it does not go away quickly, and may last for years. Most but not all children with MPGN will have long-term kidney problems. Your doctor will speak with you about how MPGN might affect your child in the future.

Urine testing at home

Your doctor may ask you to do urine tests at home to find out whether the MPGN has gone away (gone into remission) or whether it comes back (has a relapse). You will be given special, clean containers to collect the urine, and dipsticks to dip into the urine and check for any protein and/or blood in the urine. Your child’s healthcare team will show you how to do this. If there is proteinuria (a lot of protein in the urine), you will need to tell your doctor, and bring the urine sample for further testing. This may mean there is a greater risk that your child will develop long-term kidney problems.

Follow up

All children with MPGN need follow-up appointments at the hospital or clinic, to check for any health problems. These may continue throughout childhood and sometimes adulthood.

It is important to go to these appointments, even if your child seems well – remember to bring the results from your home urine testing. You will also have the opportunity to ask any questions. At these appointments, your child may have:

  • his or her height and weight checked
  • a physical examination
  • urine tests – to check for blood, protein and other substances in his or her urine
  • blood tests – to check for the amount of protein and other substances in his or her blood, and measure his or her kidney function
  • his or her blood pressure measured.

Medicines

Some children need to take angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin- II reception blockers (ARBs) over a long time, and sometimes into adulthood. 

Common ACE inhibitors are:

  • captopril
  • enalapril, and
  • lisinopril.

Doctors understand that, in some children, these medicines may reduce the risk of long-term kidney problems.

Long-term effects

Children with type 2 MPGN (dense deposit disease) are more likely than children with type 1 or type 3 MPGN to have more serious problems.

Chronic kidney disease

Some children may progress to later stages of chronic kidney disease (CKD) – their kidneys stop working as well as they should. CKD may progress to final stages of CKD (kidney failure), and these children may need specialist treatment, including dialysis and/or a kidney transplant.

Sometimes a child who had MPGN before the kidney transplant can get the disease again in the new kidney. However, this is usually less serious and does not always affect the kidney function.

If your child has progressed to later stages of CKD, you will learn more over time about what to expect and how to help manage the condition.

Impact on your child and your family

Children who have been successfully treated for MPGN can usually do the things that other children their age do. They should be able to continue going to school or nursery. They can play with other children and stay active.

Living healthily

Your child can help protect his or her kidneys by leading a healthy lifestyle through their child and adult years. This includes:

  • eating a healthy diet – with at least five servings of fruit and vegetables a day, taking care not to eat too much salt, sugar and fats (especially saturated fats)
  • getting plenty of exercise
  • not smoking.

Further support

This can be a difficult and stressful experience for your child and the whole family, including other children.

If you have any concerns or need additional support, speak with your doctor or nurse.

Further information

This is the end of the information on MPGN. If you would like to read more about other kidney conditions, tests and diagnosis, treatment or supporting information, you can find a list of topics covered on the infoKID website at www.infoKID.org.uk.

Version 1, October 2013. © RCPCH, BAPN and BKPA 2013, all rights reserved. Reviewed by: October 2016.
 
For details on any sources of information used in this topic, please contact us through the contact us form on our website www.infoKID.org.uk.
 
We take great care to make sure that the information in this leaflet is correct and up-to-date. However, it is important that you ask the advice of your child’s doctor or nurse if you are not sure about something. This information is intended for use in the United Kingdom, and may not apply to other countries. Royal College of Paediatrics and Child Health (RCPCH), British Association of Paediatric Nephrology (BAPN), British Kidney Patient Association (BKPA) and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this information.