Guideline sources The following summarized guidelines for the evaluation and management of membranoproliferative glomerulonephritis are prepared by our editorial team based on guidelines from the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2021). 1 Guidelines 1. Diagnostic investigations Evaluation for etiology (IC-MPGN): Evaluate patients with immune complex-mediated glomerulonephritis for underlying disease: Situation Guidance HCV and HBV infections, endocarditis, infected ventriculoatrial shunt, visceral abscess, leprosy, meningococcal meningitis Infections SLE, Sj gren's disease, rheumatoid arthritis, mixed connective tissue disease Autoimmune diseases Plasma cell or B-cell disorder Monoclonal gammopathy Fibrillar glomerulonephritis, idiopathic. B Other https://web.pathway.md/diseases/recWkhWrpQzYbp6Jc 1/3 6/30/23, 1:01 AM Membranoproliferative glomerulonephritis Pathway Show 2 more Evaluation for etiology (C3G): Exclude infection-related glomerulonephritis or post-infectious glomerulonephritis before establishing the diagnosis of C3 glomerulopathy. B Evaluate patients presenting for the first time with a C3 glomerulopathy diagnosis at 50 years of age for the presence of a monoclonal protein. B 2. Medical management Management of immune complex-mediated MPGN: focus on the treatment of the underlying pathologic process as the initial approach to management when the cause of immune complex- mediated glomerulonephritis is determined. B Show 7 more Management of C3 glomerulopathy: Initiate mycophenolate mofetil and corticosteroids as initial therapy in patients with moderate-to- severe C3 glomerulopathy in the absence of a monoclonal gammopathy. Consider initiating eculizumab if the initial therapy fails. B Consider offering participation in a clinical trial where available in patients not responding to the recommended treatment approaches. C Clinical findings Symptoms Past medical history Fatigue AAT deficiency Frothy urine Chronic liver disease Hematuria Cystic fibrosis Loss of appetite HBV infection Nausea HCV infection Vomiting Human immunodeficiency virus infection Vital signs Nephrotic syndrome Sickle cell disease Hypertension Vascular exam Lab findings Peripheral edema Urine RBC casts serum creatinine Hematological findings urine protein Anemia serum complement C4 https://web.pathway.md/diseases/recWkhWrpQzYbp6Jc 2/3 6/30/23, 1:01 AM Membranoproliferative glomerulonephritis Pathway References 1. Kidney Disease: Improving Global Outcomes KDIGO Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021 Oct;100 4S S1 S276. Open 2. Jeff A Simerville, William C Maxted, John J Pahira. Urinalysis: a comprehensive review. Am Fam Physician. 2005 Mar 15;71 6 1153 62. Open https://web.pathway.md/diseases/recWkhWrpQzYbp6Jc 3/3