Analysis of Prognostic Predictors in Idiopathic Membranous Nephropathy

Wu, Qiong; Jinde, Kiichiro; Nishina, Makoto; Tanabe, Ryoji; Endoh, Masayuki; Okada, Yoshikazu; Sakai, Hideto; Kurokawa, Kiyoshi

doi:10.1053/ajkd.2001.21319

Cited by 35 publications

(25 citation statements)

References 23 publications

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“…It was also interesting to note that PLA2R positivity was not useful for prognostication in primary MN. Analysis of lesions of the tubulointerstitial compartment [11–13, 19, 20] including tubular atrophy/interstitial fibrosis continue to be the most important histological prognostic indicators.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical Glomerular Expression of Phospholipase A2 Receptor in Primary and Secondary Membranous Nephropathy: A Retrospective Study in an Indian Cohort with Clinicopathological Correlations

et al. 2017

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Background: Limited published literature exists on the utility and standardization of anti-phospholipase A2 receptor (anti-PLA2R) immunohistochemistry (IHC) for the diagnosis of primary membranous nephropathy (MN). The study aimed to validate anti-PLA2R IHC for the diagnosis of primary MN and clinicopathological correlations in an Indian cohort. Methods: Subjects included patients with primary and secondary MN diagnosed between January 2012 and August 2014 with an adequate renal biopsy and at least 1 year of clinical follow-up. Anti-PLA2R IHC was performed in all cases with miscellaneous renal lesions as controls. Electron microscopy was performed in selected cases. Sensitivity and specificity of anti-PLA2R IHC to identify primary MN was evaluated. Histopathological analyses of primary and secondary MN were done with clinicopathological correlations including serum creatinine, eGFR, chronic kidney disease stage, 24-h urine protein, serum cholesterol, serum albumin, and hypertension at presentation and follow-up, using the Kruskal-Wallis test and Spearman rank correlation. A p value of ≤0.05 was considered statistically significant. Results: In 153 MN patients (99 primary, 54 secondary) and 37 miscellaneous controls, anti-PLA2R IHC differentiated primary from secondary MN with a sensitivity of 70.2% and a specificity of 96.6%. Secondary MN had increased mesangial matrix expansion compared to primary MN (p = 0.001). Severe nephrotic syndrome, impaired renal function, and hypertension were all more common in primary than in secondary MN. Conclusion: Anti-PLA2R IHC is a specific marker to distinguish primary MN from secondary MN.

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Section: Discussionmentioning

confidence: 99%

Immunohistochemical Glomerular Expression of Phospholipase A2 Receptor in Primary and Secondary Membranous Nephropathy: A Retrospective Study in an Indian Cohort with Clinicopathological Correlations

et al. 2017

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“…While this will need to be tested in a larger group of non-lupus patients than included here, it is relevant because tubulointerstitial injury, including interstitial inflammation and fibrosis is a risk factor for renal functional decline and poor response to therapy in a variety of disorders. These include membranous nephropathy, focal segmental glomerulosclerosis, IgA nephropathy, diabetic nephropathy, and renal transplant failure 21–27 . Similar to LN, interstitial inflammation appears to be a precursor to interstitial fibrosis in these diseases 27 .…”

Section: Discussionmentioning

confidence: 99%

A composite urine biomarker reflects interstitial inflammation in lupus nephritis kidney biopsies

Zhang

Nagaraja

Nádasdy

et al. 2012

Kidney International

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The therapy of lupus nephritis (LN) is mainly based on clinical data because serial biopsies are not routinely used to evaluate kidney involvement as the disease is treated and evolves. A non-invasive, real-time method to assess renal pathology could be used to titrate treatment and improve outcome. This work was undertaken to develop a urine biomarker of tubulointerstitial inflammation (TI) in LN, an injury that predisposes to renal fibrosis and chronic kidney disease. Urine samples collected at or close to the time of biopsy for LN (n=64) were used to identify potential biomarkers of TI. TI was scored by a renal pathologist using a semi-quantitative scale. Urine monocyte chemotactic protein-1 (uMCP-1), urine hepcidin (uHepcidin), and urine liver-fatty acid binding protein (uLFABP) were measured by immunoassays. Linear discriminant analysis was used to weight variables and derive composite biomarkers that identified the level of TI. The discriminant function that described the most accurate biomarker included uMCP-1 and serum creatinine as the independent variables. This composite biomarker had a sensitivity of 100%, specificity of 81%, positive predictive value of 67%, negative predictive value of 100%, and misclassified only 14% of the biopsies. In conclusion, specific renal pathologic lesions can be modeled by composite biomarkers. These biomarkers can be used to non-invasively follow and adjust the treatment of LN based on renal injury.

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“…A number of studies have attempted to identify prognostic factors for MGN based on clinical features, such as gender, age, severity of proteinuria, and the presence or absence of azotemia [9,10]. Others have correlated prognosis based on renal biopsy features [11]. A recent meta-analysis of immunosuppressive therapy for MGN in adults favored the use of alkylating agents with or without glucocorticoids over glucocorticoids alone or cyclosporine in terms of achieving complete remission [12].…”

Section: Introductionmentioning

confidence: 99%

Membranous glomerulonephritis: treatment response and outcome in children

et al. 2009

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The aim of this study was to characterize clinical features, treatment response, and outcome of idiopathic membranous glomerulonephritis (MGN) in a single-center cohort of children. A retrospective review of biopsy-proven idiopathic MGN in 12 children (mean age 11.9 years) was undertaken. Presentation was nephrotic syndrome (NS) (75%), hematuria/proteinuria (17%), and asymptomatic proteinuria (8%). Ten patients (83%) with NS and nephrotic range proteinuria (NRP) were treated with prednisone, and two patients with non-NRP were not treated with immunosuppressive medications. Steroid response in the treated patients was complete (10%), partial (40%), and absent (50%), respectively. Oral cyclophosphamide was used in seven patients of whom five were steroid resistant, one was steroid dependent, and one was partially responsive. At the mean follow up of 27 months, outcome parameters included an estimated glomerular filtration rate of 128 cc/min per 1.73 m(2), albumin of 4.2 gm/dL, and a urine protein/creatinine ratio of 0.87 [median 0.16 (range 0.02-6.52)]. Remission was complete in 75% of the patients and partial in 17%. One patient (8%) with chronic kidney disease (stage 2) was unresponsive to therapy. Complete remission was significantly associated with the absence of chronic histological changes (p = 0.03). In conclusion, children with NS and/or NRP associated with MGN appear to have a good prognosis when treated with a combination of corticosteroids and cyclophosphamide.

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Analysis of Prognostic Predictors in Idiopathic Membranous Nephropathy

Cited by 35 publications

References 23 publications

Immunohistochemical Glomerular Expression of Phospholipase A2 Receptor in Primary and Secondary Membranous Nephropathy: A Retrospective Study in an Indian Cohort with Clinicopathological Correlations

Immunohistochemical Glomerular Expression of Phospholipase A2 Receptor in Primary and Secondary Membranous Nephropathy: A Retrospective Study in an Indian Cohort with Clinicopathological Correlations

A composite urine biomarker reflects interstitial inflammation in lupus nephritis kidney biopsies

Membranous glomerulonephritis: treatment response and outcome in children

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