MPCLASS

DEPARTMENT OF PATHOLOGY, January 2003

MEMBRANOPROLIFERATIVE CHANGE (Membranoproliferative GN).CLASSIFICATION

CAMBIO MEMBRANOPROLIFERATIVO (GN Membranoproliferativa).
CLASIFICACION

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Ernesto O. Hoffmann, M.D. Professor of Pathology, LSUHSC, New Orleans, LA. USA.
email: ehoffm@lsuhsc.edu

Attempting to classify the GPs with MPC as a separate entity is not practical since MPC is a reaction of repair and may be associated to any GP. All GP with immune deposits (our Glomerulonephritis = GN), all GP with metabolic deposits (our glomerulosis = GL) and all GP due to strutural alteration of the glomerular components (our glomerular dysmorphisms) may show variable extent of MPC.
One is easily tempted to classify the GPs with MPC according to their underlying deposits. However, some substances found in our review were usually predominating but not unique and these deposits were sometimes focal and segmental and therefore, not always seen in the biopsy. Furthermore, biopsies from different patients suffering the same disease and revealing the same basic morphologic pattern in the biopsy, may or may no have MPC and may or may not have deposits. This variation probably depends on the aggressivity and chronicity of the process.

Clasificar las GP con CMP como una entidad separada no es practico por que el CMP es una reaccion de reparo que puede asociarse a todas las glomerulopatias. Todas las GP con depositos inmunes (nuestras glomerulonefritis = GN), con depositos no inmunes generalmente metabolicos (nuestras glomerulitis = GL) y todas las GP con alteraciones etsructurales de los componentes glomerulares (nuestro Dismorfismo Glomerular = DG), mostraron CMP en extension variable.
Es tentador clasificar estas GPs de acuerdo a los depositos subyacentes encontrados. Sinembargo, las substancias encontradas en nuestra revision fueron usualmente predominantes pero no unicas y estos depositos fueron unas veces difusos, globales o segmentales y focales por lo tanto no siempre visibles en la biopsias. Aun mas, biopsias de pacientes diferentes con el mismo proceso patologico y la misma morfologia pueden o no tener CMP y pueden o no tener depositos. Esta variacion probablemente depene de la agresividad y cronicidad del proceso.

Tisher and Brenner (5): Types of membranoproliferative GN.

Primary (Idiopathic): MPGN I, MPGN II, MPGN III.

Secondary (Associated with other diseases): Systemic immune complex disease. Infectious disease. Neoplasms. Chronic liver diseases. Miscellaneous.

Classification by Nakapoulou (8): Primary and secondary membranoproliferative GN.

A. Idiopathic MPGN
Type I
Type II
Type III

MPGN
Dense deposit disease
Mixed features of type I MPGN and membranous GN.

B. Secondary MPGN
i. With immune deposits:

•Infections:

Cryoglobulinemia (type II and III), HBV, HCB, endocarditis, visceral abscesses, infected ventriculo-atrial shunts, malaria, schistosomiasis, mycoplasma, EBV, HIV.

•Autoimmune diseases:

SLE, rheumatoid arthritis, Sjogreen's syndrome.

•Dysproteinemias:

Light or heavy chain deposition disease, cryoglobulinemia type I or II, Waldenstrom's macroglobulinemia, immunotactoid and fibrillary glomerulopathy.

ii. Without immune deposits:

•Chronic liver disease:

Cirrhosis, alpha one antitripsin deficiency.

•Thrombotic micoangiopathies:

HUS/TTP, anti-phospholipid antibody syndrome, radiation nephritis, sickle cell anemia, transplant glomerulopathy.

•Diabetic nephropathy:

Glomerulopathies and Membranoproliferative Change.
Hoffmann EO: Pathology, VANO and LSUHSC, New Orleans Louisiana. 2003.

GLOMERULOPATHIES WITH MEMBRANOPROLIFERATIVE CHANGE (MPC)
(Mesangial splits and endothelial splits = MPC). Nomenclarure suggested (Use % of MPC)

1. MPC with immune deposits.
(Glomerulonephritis) (MPGN)

1.1. Associated to underlying GN: Classic MPGN II (underlaying DDD), Classic MPGN III (underlaying MBGN or APGN), Mesangial GN (IgA-HS), SLE GN, Light or Heavy Chain GN, AL Amyloidosis, Fibrillary GN, Tactoid GN and Cryoglobulinemia.

Acute Proliferative GN with 20% MPC; DDD with 70% MPC.
Suggest abandon terms MPGN II and MPGN III.

1.2. Secondary to systemic diseases but no underlaying GP: HBV, HCV, HIV, endocarditis, visceral abscesses, infected atrial-ventriculo shunts, malaria, schistosomiasis, mycoplasma, lymphomas, dysproteinemias, others.

MPGN with 80% MPC secondary to Hepatitis C.

1.3. Not associated to systemic disease and no underlaying GPs: (Classic Idiopathic MPGN I)

Idiopathic MPGN with 80% MPC.

Suggest abandon term MPGN I

2. MPC without immune deposits.

(Glomerulitis) (MPGL)

2.1. Associated to underlying GP
2.1.1: MPC with underlying metabolic deposits (Glomerulosis or GO): Fabry's, AA amyloidosis, Glycogenosis I, LCAT, lipoproteinosis, cystinosis, Gaucher's.

2.1.2.GP with derragement of the glomerular components (Glomerular dysmorphism or GD): focal segmental glomerulosclerosis, diabetic nephropathy, Alport's disease, benign nephrosclerosis, Infantile mesangial sclerosis, other.

LCAT with 40% MPC; AA amyloidosis with 20% MPC.

Diabetic glomeropathy with 20% MPC; Alport's disease with 10% MPC.

2.2. Secondary to systemic diseases but no underlying GP: Chronic thrombotic micro angiopathies, HUS/TTP, anti-phospholipid antibody syndrome, chronic allograft glomerulopathy, chronic liver disease, irradiation nephritis, sickle cell anemia, toxemia of pregnancy, other.

HUS with 30% MPC; Allograft GP with 10% MPC.

2.3. MPC without underlying GP or systemic diseases (Idiopathic MPC or MPGL).

MPGL (or idiopathic MPC) with 50% MPC

*`MEMBRANOPROLIFERATIVE CHANGE (Membranoproliferative GN).``CLASSIFICATION`***

CAMBIO MEMBRANOPROLIFERATIVO (GN Membranoproliferativa).
CLASIFICACION

DEPARTMENT OF PATHOLOGY, January 2003
*`MEMBRANOPROLIFERATIVE CHANGE (Membranoproliferative GN).``CLASSIFICATION`***		*CAMBIO MEMBRANOPROLIFERATIVO (GN Membranoproliferativa).* *CLASIFICACION*
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*Volver a MPGN*	*Volver a MPGL*	*Volver a MPGN*	*Volver a MPGL*
Ernesto O. Hoffmann, M.D. Professor of Pathology, LSUHSC, New Orleans, LA. USA. email: ehoffm@lsuhsc.edu
Attempting to classify the GPs with MPC as a separate entity is not practical since MPC is a reaction of repair and may be associated to any GP. All GP with immune deposits (our Glomerulonephritis = GN), all GP with metabolic deposits (our glomerulosis = GL) and all GP due to strutural alteration of the glomerular components (our glomerular dysmorphisms) may show variable extent of MPC. One is easily tempted to classify the GPs with MPC according to their underlying deposits. However, some substances found in our review were usually predominating but not unique and these deposits were sometimes focal and segmental and therefore, not always seen in the biopsy. Furthermore, biopsies from different patients suffering the same disease and revealing the same basic morphologic pattern in the biopsy, may or may no have MPC and may or may not have deposits. This variation probably depends on the aggressivity and chronicity of the process.		Clasificar las GP con CMP como una entidad separada no es practico por que el CMP es una reaccion de reparo que puede asociarse a todas las glomerulopatias. Todas las GP con depositos inmunes (nuestras glomerulonefritis = GN), con depositos no inmunes generalmente metabolicos (nuestras glomerulitis = GL) y todas las GP con alteraciones etsructurales de los componentes glomerulares (nuestro Dismorfismo Glomerular = DG), mostraron CMP en extension variable. Es tentador clasificar estas GPs de acuerdo a los depositos subyacentes encontrados. Sinembargo, las substancias encontradas en nuestra revision fueron usualmente predominantes pero no unicas y estos depositos fueron unas veces difusos, globales o segmentales y focales por lo tanto no siempre visibles en la biopsias. Aun mas, biopsias de pacientes diferentes con el mismo proceso patologico y la misma morfologia pueden o no tener CMP y pueden o no tener depositos. Esta variacion probablemente depene de la agresividad y cronicidad del proceso.
Tisher and Brenner (5): Types of membranoproliferative GN.
Primary (Idiopathic): MPGN I, MPGN II, MPGN III.
Secondary (Associated with other diseases): Systemic immune complex disease. Infectious disease. Neoplasms. Chronic liver diseases. Miscellaneous.
Classification by Nakapoulou (8): Primary and secondary membranoproliferative GN.
A. Idiopathic MPGN Type I Type II Type III	MPGN Dense deposit disease Mixed features of type I MPGN and membranous GN.
B. Secondary MPGN i. With immune deposits:
•Infections:	Cryoglobulinemia (type II and III), HBV, HCB, endocarditis, visceral abscesses, infected ventriculo-atrial shunts, malaria, schistosomiasis, mycoplasma, EBV, HIV.
•Autoimmune diseases:	SLE, rheumatoid arthritis, Sjogreen's syndrome.
•Dysproteinemias:	Light or heavy chain deposition disease, cryoglobulinemia type I or II, Waldenstrom's macroglobulinemia, immunotactoid and fibrillary glomerulopathy.
ii. Without immune deposits:
•Chronic liver disease:	Cirrhosis, alpha one antitripsin deficiency.
•Thrombotic micoangiopathies:	HUS/TTP, anti-phospholipid antibody syndrome, radiation nephritis, sickle cell anemia, transplant glomerulopathy.
•Diabetic nephropathy:

Glomerulopathies and Membranoproliferative Change. Hoffmann EO: Pathology, VANO and LSUHSC, New Orleans Louisiana. 2003.

GLOMERULOPATHIES WITH MEMBRANOPROLIFERATIVE CHANGE (MPC) (Mesangial splits and endothelial splits = MPC).			Nomenclarure suggested (Use % of MPC)
1. MPC with immune deposits. (Glomerulonephritis) (MPGN)	1.1. Associated to underlying GN: Classic MPGN II (underlaying DDD), Classic MPGN III (underlaying MBGN or APGN), Mesangial GN (IgA-HS), SLE GN, Light or Heavy Chain GN, AL Amyloidosis, Fibrillary GN, Tactoid GN and Cryoglobulinemia.		Acute Proliferative GN with 20% MPC; DDD with 70% MPC. Suggest abandon terms MPGN II and MPGN III.
	1.2. Secondary to systemic diseases but no underlaying GP: HBV, HCV, HIV, endocarditis, visceral abscesses, infected atrial-ventriculo shunts, malaria, schistosomiasis, mycoplasma, lymphomas, dysproteinemias, others.		MPGN with 80% MPC secondary to Hepatitis C.
	1.3. Not associated to systemic disease and no underlaying GPs: (Classic Idiopathic MPGN I)		Idiopathic MPGN with 80% MPC. Suggest abandon term MPGN I

2. MPC without immune deposits. (Glomerulitis) (MPGL)	2.1. Associated to underlying GP 2.1.1: MPC with underlying metabolic deposits (Glomerulosis or GO): Fabry's, AA amyloidosis, Glycogenosis I, LCAT, lipoproteinosis, cystinosis, Gaucher's. 2.1.2.GP with derragement of the glomerular components (Glomerular dysmorphism or GD): focal segmental glomerulosclerosis, diabetic nephropathy, Alport's disease, benign nephrosclerosis, Infantile mesangial sclerosis, other.		LCAT with 40% MPC; AA amyloidosis with 20% MPC. Diabetic glomeropathy with 20% MPC; Alport's disease with 10% MPC.
	2.2. Secondary to systemic diseases but no underlying GP: Chronic thrombotic micro angiopathies, HUS/TTP, anti-phospholipid antibody syndrome, chronic allograft glomerulopathy, chronic liver disease, irradiation nephritis, sickle cell anemia, toxemia of pregnancy, other.		HUS with 30% MPC; Allograft GP with 10% MPC.
	2.3. MPC without underlying GP or systemic diseases (Idiopathic MPC or MPGL).		MPGL (or idiopathic MPC) with 50% MPC

MEMBRANOPROLIFERATIVE CHANGE (Membranoproliferative GN). CLASSIFICATION

CAMBIO MEMBRANOPROLIFERATIVO (GN Membranoproliferativa). CLASIFICACION

*`MEMBRANOPROLIFERATIVE CHANGE (Membranoproliferative GN).``CLASSIFICATION`***

CAMBIO MEMBRANOPROLIFERATIVO (GN Membranoproliferativa).
CLASIFICACION