Utility of non-HDL-C in predicting proteinuria remission of idiopathic membranous nephropathy: a retrospective cohort study

Abstract

Background Idiopathic membranous nephropathy (IMN) may have various clinical outcomes. Hyperlipidemia is quite common in IMN. However, the utility of the lipid profile in predicting outcomes remains unknown. This study aimed to explore the correlation between hyperlipidemia and proteinuria remission in IMN. Methods 256 patients who diagnosed with IMN confirmed by renal biopsy in Wuhan Tongji Hospital from January 2016 to October 2020 were included in this study. The end point was defined as a combination of partial and complete remission. Cox proportional-hazards regression analysis and Kaplan–Meier curve were applied to assess the prognostic value of the lipid profile for proteinuria remission. Results A total of 153 (59.8%) patients achieved remission and 103 (40.2%) did not. The levels of total cholesterol, low-density lipoprotein, and non-high-density lipoprotein were significantly lower in the remission group than in the non-remission group. Non-high-density lipoprotein level revealed the strongest correlation with proteinuria (Spearman’s rho = 0.42; P < 0.001). The multivariate analysis demonstrated that serum total cholesterol [hazard ratio (HR): 0.883; 95% confidence interval (CI): 0.813–0.958; P = 0.003] and non-high-density lipoprotein cholesterol (HR: 0.892; 95% CI: 0.820–0.970; P = 0.007) levels were independent markers to predict proteinuria remission in IMN. Conclusions Among the lipid profile, the non-high-density lipoprotein level exhibited the strongest correlation with proteinuria in IMN. Moreover, elevated serum cholesterol and non-high-density lipoprotein cholesterol concentrations at baseline predicted probability of proteinuria non-remission in IMN.

Hypercholesterolemia Correlates With Glomerular Phospholipase A2 Receptor Deposit and Serum Anti-Phospholipase A2 Receptor Antibody and Predicts Proteinuria Outcome in Idiopathic Membranous Nephropathy

“…PLA2R has been considered the major target antigen for IMN, and anti-PLA2R is a widely accepted diagnostic and prognostic biomarker (17). Our preliminary results indicated that hypercholesterolemia at baseline is an independent risk factor for persistent proteinuria in IMN (11). Herein, we found that hypercholesterolemia at onset was correlated with glomerular and tubular lesions, glomerular PLA2R deposit, and serum anti- PLA2R titers in a large Chinese cohort.…”

“…In the present study, triglyceride (TG), total cholesterol (TC), highdensity lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) were evaluated as lipid profiles and their roles evaluated in IMN. In a previous study, we demonstrated that hypercholesterolemia at baseline is an independent risk factor for non-remission of proteinuria in IMN patients (11). However, whether hyperlipidemia is correlated with the outcomes via any pathological parameter remains to be clarified.…”

“…Patients with the following criteria were excluded: (i) use of steroid and immunosuppressants within 6 months before screening; (ii) use of lipid-lowering medication upon admission; and (iii) MN secondary to known causes, including hepatitis virus infection, tumor, autoimmune disease, and metabolic disease. Data extraction and analyses were conducted as described previously (11).…”

“…Previously, we reported that low TC and non-HDL-C levels pretherapy were independent predictors for proteinuria remission in IMN patients (11). To determine the effect of lipid control on proteinuria remission, a multivariate Cox regression analysis was carried out on 236 participants who had complete follow-up data.…”

PLA2G12B Mediates Arachidonic Acid Metabolism through Activation of the NF-κB Pathway to Promote Membrane Nephropathy

“…Hypercholesterolemia was proven to be associated with glomerular PLA2 receptor deposition and independently predicted proteinuric outcome in patients with MN [4]. Dong et al [21] reviewed 256 patients with MN diagnosed by renal biopsy, and lipid profiling found that non-HDL levels correlated most strongly with proteinuria. In our MN model mice, except for the elevated levels of kidney and liver injury indicators in serum, the levels of lipid metabolism indicators, TC, TG, and AA metabolism indicators, including AA, PGI 2 , TXA 2 , and LTB 4 , were significantly higher, which is consistent with previous reports [22].…”