Factors affecting the long-term outcomes of idiopathic membranous nephropathy

Abstract

BackgroundWe attempted to describe the clinical features and determine the factors associated with renal survival in idiopathic membranous nephropathy (iMN) patients with nephrotic syndrome (NS) and to determine the factors associated with spontaneous complete remission (sCR) and progression to NS in iMN patients with subnephrotic proteinuria.MethodsThis retrospective study involved 166 iMN patients with NS and 65 patients with subnephrotic proteinuria. The primary end point was a doubling of serum creatinine or initiation of dialysis. In patients with subnephrotic proteinuria, we determined the factors associated with sCR and factors associated with progression to NS.ResultsRemission of NS was achieved in 125 out of 166 patients (75.3%). Of those who reached remission, 26 patients (20.8%) experienced relapse that was followed by second remission. The relapse or persistence of proteinuria was associated with the primary end points (hazard ratio [HR] = 12.40, P = 0.037, HR = 173, P < 0.001, respectively). In patients with subnephrotic proteinuria, sCR occurred in 35.4% of the patients. The patients with sCR had lower proteinuria and serum creatinine levels and higher serum albumin concentrations at baseline. The serum albumin level at diagnosis was a prognostic factor for progression to NS (Odds ratio [OR] = 0.015, P < 0.001).ConclusionsThe occurrence of relapse or persistence of proteinuria had negative effects on renal survival in iMN patients with NS, and low serum albumin levels at baseline were associated with non-achievement of sCR and progression to NS.

Association between the HLA-DQA1 rs2187668 polymorphism and risk of idiopathic membranous nephropathy

“…iMN is a multifactorial disease, which interactions between many factors including age, gender, and so on. [ 21 ] But data for people of different age and gender were limited, and data were not available to perform subgroup analyses based on age or gender. Anyway, our result indicated that HLA-DQA1 gene polymorphism was associated with iMN risk.…”

Comparative efficacy of 13 immunosuppressive agents for idiopathic membranous nephropathy in adults with nephrotic syndrome: a systematic review and network meta-analysis

“…Since the clinical features and prognosis of IMN are variable, the disease has a high rate of spontaneous remission. Spontaneous complete remission (CR) of proteinuria is observed after a variable period of time (4–120 months) in approximately 30%–40% of adult patients 2 3. Despite this, 30%–40% of patients progress toward end-stage renal failure within 5–15 years 4…”

Clinicopathological features and prognosis in patients with idiopathic membranous nephropathy with hypertension

“…In the present study, a multivariate Cox proportional hazards regression analysis was performed to investigate the association of DBP with renal outcomes. A previous study showed that patients with IMN suffered from CKD as a result of hypertension, and that hypertension was secondary to renal disease (18). Therefore, monitoring BP during diagnosis in patients with IMN may facilitate prognosis.…”

“…Moreover, the present study identified that Scr, LDL and 24 h urine protein were increased, and serum albumin and e-GFR were decreased in patients with IMN with hypertension. Huh et al (18) reported that low serum albumin levels at the onset of the disease were associated with poor renal prognosis of patients with IMN. Another previous study reported that high levels of Scr at diagnosis are major predictors of the progression of IMN to ESRD (30).…”

“…According to the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines for glomerulonephritis, IMN can be diagnosed by kidney biopsy (16). Patients with systemic diseases, such as rheumatic diseases, malignant tumors, hepatitis B or C virus infection, tuberculosis and other kidney diseases were excluded from the study (17)(18)(19)(20). Patients <18 years old were also excluded.…”