Pediatric Nephrology

, Volume 27, Issue 12, pp 2243–2250

Trends in pediatric primary membranoproliferative glomerulonephritis costs and complications

  • Chang-Ching Wei
  • Wei Wang
  • William E. Smoyer
  • Christoph Licht
Original Article



Data on pediatric membranoproliferative glomerulonephritis (MPGN) epidemiology, complications, and healthcare costs are critical to our understanding of MPGN’s economic burden and of how best to direct clinical care and research efforts in the future.


We analyzed 10-year trends in epidemiology, complications, and hospital charges for pediatric primary MPGN hospitalizations using the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) for 1997–2006. We identified approximately 320 primary MPGN admissions per year, corresponding to approximately 4.3 % of all glomerular disease admissions.


Older children were at higher risk for admission (odds ratios for ages 6–10, 11–15, and 16–18 years were 7.5, 9.3, and 4.7, respectively compared to 0–5 years; p < 0.0001). Gender, race, income, hospital location, and admission season were not significant risk factors. The incidence of MPGN admission-associated acute renal failure (ARF) increased to >147 % (from <3 to 7.4 %) over time, while admission-associated renal biopsy (approx. 34.8 %), renal replacement therapy (approx. 18.4 %), and transplantation (approx. 5 %) remained constant. Hospital length of stay (LOS) increased by 68 % (from 5.0 to 8.4 days), whereas mean total hospital charges increased by 213 % (from $13,718 to $42,891), concomitant with a strong trend from private toward public health insurance.


We conclude that while the incidence of pediatric primary MPGN hospitalizations has remained stable over the last 10 years, they have been associated with marked increases in the frequency of ARF, as well as dramatically increased hospital LOS and charges.


Membranoproliferative glomerulonephritis Pediatric nephrology Hospitalization Cost 


  1. 1.
    West CD, McAdams AJ, McConville JM, Davis NC, Holland NH (1965) Hypocomplementemic and normocomplementemic persistent (chronic) glomerulonephritis: clinical and pathologic characteristics. J Pediatr 67:1089–1112CrossRefGoogle Scholar
  2. 2.
    Habib R, Kleinknecht C, Gubler M, Levy M (1973) Idiopathic membranoproliferative glomerulonephritis in children. Report of 105 cases. Clin Nephrol 1:194–214PubMedGoogle Scholar
  3. 3.
    Schwertz R, De Jong R, Gretz N, Kirschfink M, Anders D, Schärer K (1996) Outcome of idiopathic membranoproliferative glomerulonephritis in children. Acta Pediatr 85:308–312CrossRefGoogle Scholar
  4. 4.
    Iitaka K, Nakamura S, Moriya S, Koshino H, Iwanami N, Sakai T, Motoyama O (2005) Hypocomplementemia and membranoproliferative glomeruloneophritis in children. Clin Exp Nephrol 9:31–33PubMedCrossRefGoogle Scholar
  5. 5.
    Covic A, Schiller A, Volovat C, Gluhovschi G, Gusbeth-Tatomir P, Petrica L, Caruntu ID, Bozdog G, Velciov S, Trandafirescu V, Bob F, Gluhovschi C (2006) Epidemiology of renal disease in Romania: a 10 year review of two regional renal biopsy databases. Nephrol Dial Transplant 21:419–424PubMedCrossRefGoogle Scholar
  6. 6.
    Asinobi AO, Gbadegesin RA, Adeyemo AA, Akang EE, Arowolo FA, Abiola OA, Osinusi K (1999) The predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria. West Afr J Med 18:203–206PubMedGoogle Scholar
  7. 7.
    Chang JH, Kim DK, Kim HW, Park SY, Yoo TH, Kim BS, Kang SW, Choi KH, Han DS, Jeong HJ, Lee HY (2009) Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience. Nephrol Dial Transplant 24:2406–2410PubMedCrossRefGoogle Scholar
  8. 8.
    Safaei A, Maleknejad S (2009) Spectrum of childhood nephrotic syndrome in Iran: a single center study. Indian J Nephrol 19:87–90PubMedCrossRefGoogle Scholar
  9. 9.
    Swaminathan S, Leung N, Lager DJ, Melton LJ 3rd, Bergstralh EJ, Rohlinger A, Fervenza FC (2006) Changing incidence of glomerular disease in Olmsted County, Minnesota: a 30-year renal biopsy study. Clin J Am Soc Nephrol 1:483–487PubMedCrossRefGoogle Scholar
  10. 10.
    Werner T, Brodersen HP, Janssen U (2009) Analysis of the spectrum of nephropathies over 24 years in a West German center based on native kidney biopsies. Med Klin (Munich) 104:753–759CrossRefGoogle Scholar
  11. 11.
    Hanko JB, Mullan RN, O’Rourke DM, McNamee PT, Maxwell AP, Courtney AE (2009) The changing pattern of adult primary glomerular disease. Nephrol Dial Transplant 24:3050–3054PubMedCrossRefGoogle Scholar
  12. 12.
    Ben Maiz H, Abderrahim E, Ben Moussa F, Goucha R, Karoui C (2006) Epidemiology of glomerular diseases in Tunisia from 1975 to 2005. Influence of changes in healthcare and society. Bull Acad Natl Med 190:403–416, discussion 416–408PubMedGoogle Scholar
  13. 13.
    Jalalah SM, Jamal AA (2009) Childhood primary glomerular diseases in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl 20:608–612PubMedGoogle Scholar
  14. 14.
    Ozkaya N, Cakar N, Ekim M, Kara N, Akkök N, Yalçinkaya F (2004) Primary nephrotic syndrome during childhood in Turkey. Pediatr Int 46:436–438PubMedCrossRefGoogle Scholar
  15. 15.
    Benz K, Amann K (2009) Pathological aspects of membranoproliferative glomerulonephritis (MPGN) and haemolytic uraemic syndrome (HUS) / thrombocytic thrombopenic purpura (TTP). Thromb Haemost 101:265–270PubMedGoogle Scholar
  16. 16.
    Alchi B, Jayne D (2010) Membranoproliferative glomerulonephritis. Pediatr Nephrol 25:1409–1418PubMedCrossRefGoogle Scholar
  17. 17.
    Licht C, Schlotzer-Schrehardt U, Kirschfink M, Zipfel PF, Hoppe B (2007) MPGN II—genetically determined by defective complement regulation? Pediatr Nephrol 22:2–9PubMedCrossRefGoogle Scholar
  18. 18.
    Licht C, Fremeaux-Bacchi V (2009) Hereditary and acquired complement dysregulation in membranoproliferative glomerulonephritis. Thromb Haemost 101:271–278PubMedGoogle Scholar
  19. 19.
    Skerka C, Licht C, Mengel M, Uzonyi B, Strobel S, Zipfel PF, Józsi M (2009) Autoimmune forms of thrombotic microangiopathy and membranoproliferative glomerulonephritis: Indications for a disease spectrum and common pathogenic principles. Mol Immunol 46:2801–2807PubMedCrossRefGoogle Scholar
  20. 20.
    Barbiano di Belgiojoso G, Baroni M, Pagliari B, Lavagni MG, Porri MT, Banfi G, Colasanti G, Confalonieri R (1985) Is membranoproliferative glomerulonephritis really decreasing? A multicentre study of 1,548 cases of primary glomerulonephritis. Nephron 40:380–381PubMedCrossRefGoogle Scholar
  21. 21.
    Iitaka K, Nakamura S, Moriya S, Koshino H, Iwanami N, Sakai T, Motoyama O (2005) Hypocomplementemia and membranoproliferative glomeruloneophritis in children. Clin Exp Nephrol 9:31–33PubMedCrossRefGoogle Scholar
  22. 22.
    Levey A, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G, Foundation NK (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147PubMedGoogle Scholar
  23. 23.
    Bagshaw S, George C, Bellomo R, ANZICS Database Management Committe (2008) A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 23:1569–1574PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2012

Authors and Affiliations

  • Chang-Ching Wei
    • 1
    • 2
  • Wei Wang
    • 3
  • William E. Smoyer
    • 3
  • Christoph Licht
    • 4
    • 5
  1. 1.Department of Pediatrics, Division of NephrologyChina Medical University HospitalTaichungTaiwan
  2. 2.China Medical UniversityTaichungTaiwan
  3. 3.Division of Nephrology, Nationwide Children’s HospitalCenter for Clinical and Translational ResearchColumbusUSA
  4. 4.Division of NephrologyThe Hospital for Sick ChildrenTorontoCanada
  5. 5.University of TorontoTorontoCanada

Personalised recommendations