In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 10 ( 2022-10-13), p. e0276053-
Abstract:
Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. Methods 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. Results Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%] . Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p 〈 0.001). The median follow-up period was 59.5 months. Conclusion We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0276053
DOI:
10.1371/journal.pone.0276053.g001
DOI:
10.1371/journal.pone.0276053.g002
DOI:
10.1371/journal.pone.0276053.g003
DOI:
10.1371/journal.pone.0276053.g004
DOI:
10.1371/journal.pone.0276053.t001
DOI:
10.1371/journal.pone.0276053.t002
DOI:
10.1371/journal.pone.0276053.t003
DOI:
10.1371/journal.pone.0276053.t004
DOI:
10.1371/journal.pone.0276053.t005
DOI:
10.1371/journal.pone.0276053.s001
DOI:
10.1371/journal.pone.0276053.s002
DOI:
10.1371/journal.pone.0276053.s003
DOI:
10.1371/journal.pone.0276053.s004
DOI:
10.1371/journal.pone.0276053.r001
DOI:
10.1371/journal.pone.0276053.r002
DOI:
10.1371/journal.pone.0276053.r003
DOI:
10.1371/journal.pone.0276053.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
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