Association of diabetes with failure to achieve complete remission of idiopathic membranous nephropathy

Xie, H Y; Li, Chao; Wen, Yubing; Ye, Wei; Cai, Jun; Li, Hang; Li, Xuemei; Li, Xuewang

doi:10.1007/s11255-019-02348-2

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…In our study, multivariate regression analysis revealed that diabetes and smoking were independent risk factors affecting the response to immunotherapy in patients with IMN. Our present results were consistent with previous papers (22)(23)(24). Patients with IMN and diabetes respond poorly to immunosuppressive regimens, with poor glycemic control being the most common side effect.…”

Section: Discussionsupporting

confidence: 94%

Prediction of immunotherapy response in idiopathic membranous nephropathy using deep learning-pathological and clinical factors

Wei,

Long,

Fan

et al. 2024

Front. Endocrinol.

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BackgroundOwing to individual heterogeneity, patients with idiopathic membranous nephropathy (IMN) exhibit varying sensitivities to immunotherapy. This study aimed to establish and validate a model incorporating pathological and clinical features using deep learning training to evaluate the response of patients with IMN to immunosuppressive therapy.MethodsThe 291 patients were randomly categorized into training (n = 219) and validation (n = 72) cohorts. Patch-level convolutional neural network training in a weakly supervised manner was utilized to analyze whole-slide histopathological features. We developed a machine-learning model to assess the predictive value of pathological signatures compared to clinical factors. The performance levels of the models were evaluated using the area under the receiver operating characteristic curve (AUC) on the training and validation tests, and the prediction accuracies of the models for immunotherapy response were compared.ResultsMultivariate analysis indicated that diabetes and smoking were independent risk factors affecting the response to immunotherapy in IMN patients. The model integrating pathologic features had a favorable predictive value for determining the response to immunotherapy in IMN patients, with AUCs of 0.85 and 0.77 when employed in the training and test cohorts, respectively. However, when incorporating clinical features into the model, the predictive efficacy diminishes, as evidenced by lower AUC values of 0.75 and 0.62 on the training and testing cohorts, respectively.ConclusionsThe model incorporating pathological signatures demonstrated a superior predictive ability for determining the response to immunosuppressive therapy in IMN patients compared to the integration of clinical factors.

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Section: Discussionsupporting

confidence: 94%

Prediction of immunotherapy response in idiopathic membranous nephropathy using deep learning-pathological and clinical factors

Wei,

Long,

Fan

et al. 2024

Front. Endocrinol.

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“…DM may also make achieving complete remission challenging. [28] Treatment-related adverse effects were another important aspect that required attention in our study. Studies have indicated that patients treated with tacrolimus had a higher risk of nephrotoxicity, increased Scr, and reduced eGFR.…”

Section: Discussionmentioning

confidence: 99%

The Combination Therapy of Glucocorticoids, Tacrolimus, and Mycophenolate Mofetil in Primary Membranous Nephropathy Coexisting with Type 2 Diabetes Mellitus: A Retrospective Study

Wang

Cui

Tian

et al. 2023

Integr Med Nephrol Androl

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Background: Primary membranous nephropathy (pMN) is treated with glucocorticoids or immunosuppressive agents, depending on the disease severity. However, treating pMN with type 2 diabetes mellitus (T2DM) remains challenging. Methods: We retrospectively collected and analyzed the data of patients diagnosed with pMN and T2DM. The low-dose multitarget regimen consists of prednisone (10 mg/d), tacrolimus (0.05 mg/kg/d, blood concentration 5–10 ng/mL), and mycophenolate mofetil (1 g/d); The cyclophosphamide (CTX) regimen consists of prednisone (initial dose 1 mg/kg/d) and CTX (0.8–1.0 g/month, cumulative dose 6–9 g). Results: Sixty-seven patients were diagnosed with pMN and T2DM, and 28 were enrolled in this study, with 14 cases each in the low-dose multitarget and CTX groups. Urinary protein excretion decreased significantly in both groups after treatment, which was significantly greater in the low-dose multitarget group than that in the CTX group (2 months: −4800.48 ± 3002.65 mg/24h versus −1663.32 ± 4113.98 mg/24h, P−BH = 0.045; 12 months: −7289.25 ± 2520.92 mg/24h versus −4512.79 ± 3448.85 mg/24h, P−BH = 0.044). Serum albumin levels increased more in the low-dose multitarget group than in the CTX group, although the difference was not significant. Patients treated with glucocorticoids plus CTX had worse glycemic control in two months. Conclusion: The combination of glucocorticoids, tacrolimus, and mycophenolate mofetil was effective for treating pMN with T2DM and not inferior to the CTX regimen in proteinuria reduction. Further studies are needed to confirm the regimen's influence on blood glucose and long-term efficacy.

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“…Xie et al [ 21 ] compared the remission rate of patients with or without DM and concluded that even though patients with concomitant DM experienced worse renal function deterioration, no significant differences were found in remission rates between the two groups. However, another study also conducted in China, but with a larger sample size, demonstrated that concomitant DM at IMN presentation is an independent risk factor for failure to achieve CR [ 22 ]. Results of the present study may reflect that FBG is a more sensitive indicator compared to DM, or just that the selection of statistical methods resulted in this finding, which needs further evaluation to clarify the different roles of FBG and DM in risk assessment for patients with IMN.…”

Section: Discussionmentioning

confidence: 99%

Urine albumin-to-creatinine ratio diurnal variation rate predicts outcomes in idiopathic membranous nephropathy

Chen,

Zhang,

Yan

et al. 2024

Clin Exp Nephrol

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Background Idiopathic membranous nephropathy (IMN) is a leading cause of end-stage renal disease (ESRD). The purpose of this study was to evaluate whether urinary albumin-to-creatinine ratio (UACR) diurnal variation rate calculated by spot urinary protein test predicts 1-year nephrotic outcomes as a biomarker of proteinuria severity in patients with IMN. Methods Patients’ baseline demographics, blood and urinary biomarkers, and clinical and pathological characteristics were collected retrospectively. Urine samples were collected at 7:00 (before breakfast) and 19:00 (after dinner) to calculate the UACR diurnal variation rate. A prediction model for no remission (NR) was developed statistically based on differences between prognosis groups. Receiver operating characteristic curve (ROC) analysis was performed to evaluate prediction abilities and determine optimal cut-off points of the model and UACR diurnal variation rate alone. Results The formula for calculating the probability of NR was exp(L)/(1 + exp(L)), where the linear predictor L = – 22.038 + 0.134 × Age (years) + 0.457 × 24-h urinary protein + 0.511 × blood urea nitrogen (BUN) + 0.014 × serum uric acid (SUA) + 2.411 if glomerular sclerosis + 0.816 × fasting blood glucose (FBG)-0.039 × UACR diurnal variation rate (%). Optimal cut-off points for NR prediction by the final model and UACR diurnal variation rate alone were 0.331 and 58.5%, respectively. Sensitivity and specificity were 0.889 and 0.859 for the final model, and 0.926 and 0.676 for UACR diurnal variation rate alone. Conclusion UACR diurnal variation using spot urinary protein is a simpler way to predict nephrotic outcomes and is a highly sensitive screening tool for identifying patients who should undergo further comprehensive risk assessment.

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Association of diabetes with failure to achieve complete remission of idiopathic membranous nephropathy

Cited by 5 publications

References 27 publications

Prediction of immunotherapy response in idiopathic membranous nephropathy using deep learning-pathological and clinical factors

Prediction of immunotherapy response in idiopathic membranous nephropathy using deep learning-pathological and clinical factors

The Combination Therapy of Glucocorticoids, Tacrolimus, and Mycophenolate Mofetil in Primary Membranous Nephropathy Coexisting with Type 2 Diabetes Mellitus: A Retrospective Study

Urine albumin-to-creatinine ratio diurnal variation rate predicts outcomes in idiopathic membranous nephropathy

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