Treatment of Membranoproliferative Glomerulonephritis in Children Younger Than 12 Years with C3 Glomerulopathy or IC-MPGN
Children under 12 years with membranoproliferative glomerulonephritis represent a population that has been largely excluded from randomised controlled trials, creating a significant evidence gap that makes structured clinical guidance especially important for this age group.
Clinical Scenario
This protocol applies to children younger than 12 years presenting with C3 glomerulopathy or primary immune complex membranoproliferative glomerulonephritis (IC-MPGN). Given that trial data have excluded patients below this age threshold, the available clinical experience for this group derives from small cohorts and compassionate-use cases — underscoring the urgency of a structured approach to this presentation.
Treatment Approach (partial overview)
When biopsy findings show inflammatory changes, an immunosuppressive strategy is employed. For IC-MPGN patients who do not respond, escalation to B-cell depletion is among the options considered. The complete sequence, decision criteria, and full regimen are available in the protocol.
References
Finally, it is important to acknowledge that randomized controlled trials have excluded patients aged < 12 years and as such, the only experience of complement inhibitor therapy in this group comes from small cohorts or individual cases of compassionate use.
This represents an urgent unmet need as the disease onset in children often occurs before 12 years of age.
Where there are inflammatory changes within biopsies, immunosuppression has been used, most commonly glucocorticoid therapy and mycophenolate mofetil, with escalation to B-cell depletion with rituximab considered in IC-MPGN patients with no improvement.
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