Nephrotic Syndrome Secondary to Primary Membranoproliferative Glomerulonephritis in a 27 Years Old Nigerian Male

Abstract: Membranoproliferative glomerulonephritis (MPGN) is not a common cause of nephrotic syndrome (NS) in adults unlike in children. It is commonly steroid-resistant in adults unlike in children. Tissue diagnosis needed for effective management could be unavailable due to cost, particularly in resource poor settings. Patient was examined, had urine analysis, serum biochemistry assay, kidney scan and a kidney biopsy for histological diagnosis. The patient had generalized oedema, with ascites, elevated blood pressure (156/90 mmHg) and massive proteinuria (4.6 g/day). The haemogram showed haematocrit of 32%, with absolute lymphocytosis (72%). Fasting lipids showed hypercholesterolemia (533 mg/dl), elevated LDL (274 mg/dl), low HDL (27 mg/dl) and hypertriglyceridemia (302 mg/dl). Ultrasound showed enlarged kidneys. Histological findings were mesangial hypercellularity, double-contour formation along the glomerular capillary wall (tram track appearance) and endocapillary proliferation. He was managed with intravenous methylprednisolone, (followed by gradually reducing oral doses), frusemide, atorvastatin, antibiotics and had daily weighing. He responded well to treatment. He was counselled on good compliance and has been on follow-up visits. His clinical and laboratory parameters have been normal. Nephrotic syndrome from MPGN should be looked out for in adults presenting with NS and their treatment with steroids could be very beneficial.