Clinical and morphological prognostic factors in membranous nephropathy: Significance of focal segmental glomerulosclerosis

Meta-Analysis of Association between Pathological Characteristics and Renal Outcomes in Adult Idiopathic Membranous Nephropathy

“…Dumoulin et al found that segmental sclerosis was superimposed in 30 of 72 IMN patients [35]. Multiple regression analysis confirmed that segmental sclerosis was independently associated with progression to renal insufficiency.…”

“…A total of 2080 patients with 252 hard endpoints (renal insufficiency or ESRD) were reported [16,19,[31][32][33]35,[38][39][40]. Seven studies reported the number of patients who developed renal insufficiency during follow-up, and eight studies reported the number of patients who reached ESRD during follow-up.…”

“…However, this was not independent of baseline renal function, age, and blood pressure at biopsy. Three studies did not examine the predictive value of tubular atrophy or interstitial fibrosis because of the strong association with segmental sclerosis [35,40] or baseline renal function [38]. In the present meta-analysis, the association of tubular atrophy and interstitial fibrosis with renal outcomes was quantitatively summarized in seven of nine included studies with 1569 patients.…”

“…Five studies failed to identify a significant association of arteriosclerosis with renal outcomes in multivariate analysis [19,[31][32][33]35]. The remaining three studies did not examine the association of arteriosclerosis with renal outcomes [38][39][40].…”

Lupus Nephritis

“…The interpretation of segmentally sclerosing lesion in membranous LN class V can be particularly challenging. Segmental sclerosis is common in chronic idiopathic membranous glomerulopathy ( Figure 3) (14), and thus, it may be difficult to distinguish this nonspecific sclerosis from chronic class III or IV lesions. Furthermore, a membranous pattern with segmental sclerosis may be a manifestation of class V LN with superimposed class III or class IV(S) lesions that are now chronic, a possibility that is not captured in the ISN/RPS classification.…”