New risk score for predicting progression of membranous nephropathy

Abstract

BackgroundPatients with Idiopathic membranous nephropathy (IMN) have various outcomes. The aim of this study is to construct a tool for clinicians to precisely predict outcome of IMN.MethodsIMN patients diagnosed by renal biopsy from Shanghai Ruijin Hospital from 2009.01 to 2013.12 were enrolled in this study. Primary outcome was defined as a combination of renal function progression [defined as a reduction of estimated glomerular filtration rate (eGFR) equal to or over 30% comparing to baseline], ESRD or death. Risk models were established by Cox proportional hazard regression analysis and validated by bootstrap resampling analysis. ROC curve was applied to test the performance of risk score.ResultsTotally 439 patients were recruited in this study. The median follow-up time was 38.73 ± 19.35 months. The enrolled patients were 56 (15–83) years old with a male predominance (sex ratio: male vs female, 1:0.91). The median baseline serum albumin, eGFR-EPI and proteinuria were 23(8–43) g/l, 100.31(12.81–155.98) ml/min/1.73 m2 and 3.98(1.50–22.98) g/24 h, respectively. In total, there were 36 primary outcomes occurred. By Cox regression analysis, the best risk model included age [HR: 1.04(1.003–1.08), 95% CI from bootstrapping: 1.01–1.08), eGFR [HR: 0.97 (0.96–0.99), 95% CI from bootstrapping: 0.96–0.99) and proteinuria [HR: 1.09 (1.01–1.18), 95% CI from bootstrapping: 1.02–1.16). One unit increasing of the risk score based on the best model was associated with 2.57 (1.97–3.36) fold increased risk of combined outcome. The discrimination of this risk score was excellent in predicting combined outcome [C statistics: 0.83, 95% CI 0.76–0.90].ConclusionsOur study indicated that older IMN patients with lower eGFR and heavier proteinuria at the time of renal biopsy were at a higher risk for adverse outcomes. A risk score based on these three variables provides clinicians with an effective tool for risk stratification.Electronic supplementary materialThe online version of this article (10.1186/s12967-019-1792-8) contains supplementary material, which is available to authorized users.

RETRACTED: Role of Serum and Urine Biomarkers (PLA2R and THSD7A) in Diagnosis, Monitoring and Prognostication of Primary Membranous Glomerulonephritis

“…Primary membranous glomerulonephritis (MGN) is one of the most common types of primary glomerulonephritis among adults [1,2], associated with a frequent increase in prevalence in Southeast Asia [3] and Malaysia [4] in particular. Although biopsy remains the confirmatory test for MGN, the clinical outcome is variable and often unpredictable.…”

Advances of the experimental models of idiopathic membranous nephropathy (Review)

“…chronic kidney disease (cKd) is becoming a serious public health problem because it is related to an increased risk of cardiovascular disease and mortality (1)(2)(3)(4). as one of the main types of cKd, membranous nephropathy (Mn), is an autoimmune disease characterized by diffuse deposition of immune complexes under glomerular epithelial cells (Gecs), with diffuse thickening of the glomerular basement membrane (GBM) (5,6). according to primary diseases, Mn can be categorized into idiopathic membranous nephropathy (iMn) and secondary membranous nephropathy (SMn), while iMn accounts for approximately 80% of the total incidence of Mn (7).…”

Idiopathic membranous nephropathy in older patients: Clinical features and outcomes

“…Because iMN occurs frequently in older patients, many investigators are interested in the relationship between renal outcomes and age. Although some studies have shown that older patients with iMN had a poor prognosis [ 8 , 16 , 17 ], a recent study that analyzed Japanese data showed that younger and older patients with iMN had similar renal outcomes [ 15 ]. Generally, at the time of biopsy, the initial eGFR is lower in older patients than in younger patients; consequently, older patients might reach renal failure faster than younger patients.…”

“…In addition to proteinuria levels, age and eGFR have been reported as predictors of outcome in patients with iMN. Although younger and older patients with iMN had comparable renal outcomes in a recent Japanese multicenter study [15], other studies showed that older age was associated with inferior renal survival [8,16,17]. A low eGFR at disease presentation was also reported to be associated with poor renal outcomes [16,18].…”

“…Many factors can affect the clinical course and prognosis of iMN. The baseline level of proteinuria in the nephrotic range is an indicator of reduced kidney function in patients with iMN [7,8]. Patients with high proteinuria levels at the time of biopsy had worse outcomes, in terms of reduction in the estimated glomerular filtration rate (eGFR) or the progression to ESRD.…”