Acute arterial cardiovascular events risk in patients with primary membranous nephropathy

Abstract

Background Venous thromboembolism is a well established risk in patients with primary membranous nephropathy (MN) due to deficiency in natural anti‐coagulants. Recent studies suggested a higher risk of arterial thrombotic events as well in this group. Aim To identify that risk in our cohort. Methods We reviewed the data of all patients who had biopsy proven primary MN at our institute between 2003 and 2013. Clinical data were retrospectively reviewed until November 2016. The cardiovascular (CV) events, including acute coronary syndromes and strokes were determined and included only if occurred after the diagnosis of the nephropathy. Results A total of 204 patients had biopsy proven MN. Follow up information was available for 166 patients. Thirty‐one patients (18.6%) developed CV events during follow up. Thirty‐eight per cent of total events occurred within 1 year of MN diagnosis. Forty‐two per cent of those who developed CV events were not on anti‐thrombotic medications and 60% were not on statin therapy. Male gender, age, diabetes and absence of statins therapy were associated with higher rates of CV events in this group. Conclusion There is an increased risk of arterial events in patients with primary MN. This risk is greatest in the first year of diagnosis. The risk should be highlighted in this group of patients and anti‐platelets and statin therapy should be considered especially during the initial phase of the disease.

Long-Term Follow-Up of Cyclical Cyclophosphamide and Steroids Versus Tacrolimus and Steroids in Primary Membranous Nephropathy

“… 16 However, to find a meaningful difference in the progression to advanced kidney failure or death requires more than 2 years of follow-up in an indolent disease such as PMN. Nonetheless, there is an enhanced risk of complications of the nephrotic syndrome such as infection, malnutrition, chronic diuretic use for edema resolution, endothelial dysfunction, 17 and accelerated atherosclerosis 18 , 19 with repeated relapses. These comorbidities likely have an unfavorable influence on long-term kidney and patient health.…”

Membranous nephropathy and cardiovascular events

“…We have read with great interest the article published by Alawami et al ., which was about increased frequency of major cardiovascular events in patients with primary membranous nephropathy (MN). It is reported in the article that arterial cardiovascular events are increased in patients with primary MN and gender, age, statin use and diabetes are the predictive factors of cardiovascular events in this patient group …”

Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022

“…A meta-analysis that evaluated cardiovascular presenting with refractory nephrotic syndrome are middle-aged and older people, are prone to arteriovenous thromboembolism, and are treated with prolonged steroid therapy, drugs for dyslipidemia are considered highly necessary 1449) .…”