Baseline proteinuria level is associated with prognosis in idiopathic membranous nephropathy

Abstract

Objectives: This study aimed to investigate the unique prognostic, clinical, and renal histopathological characteristics of patients with idiopathic membranous nephropathy (IMN) with different levels of proteinuria. Methods: This retrospective observational study included 190 IMN patients with low levels of proteinuria (low group), 193 IMN patients with medium levels of proteinuria (medium group), and 123 IMN patients with high levels of proteinuria (high group) treated between September 2006 and November 2015. Prognostic and baseline clinical and histopathological data were compared among the three groups. Poor prognostic events included the occurrence of a persistent 50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease, or all-cause mortality. Results: The severity of clinical symptoms and laboratory indices, such as blood pressure; extent of edema and hematuria; levels of fibrinogen, immunoglobulin (Ig)-G, complement (C)-4, total protein, albumin (ALB), and serum creatinine (SCr); and eGFR increased with increasing proteinuria (all p < .001). Based on renal histopathology, the extent of segmental sclerosis and balloon adhesion and renal interstitial lesion stage also increased in severity with increasing proteinuria (all p < .001). The Kaplan–Meier analysis showed that compared with patients with low and medium levels of proteinuria, patients with high levels of proteinuria had significantly lower cumulative poor event-free renal survival rates ( p = .0039). Conclusions: Baseline proteinuria level is indicative of prognosis in IMN patients; the greater the extent of proteinuria is, the worse the prognosis.

Effectiveness and safety of cyclophosphamide or tacrolimus therapy for idiopathic membranous nephropathy

“…Recently, researches from oriental cohorts all emphasized the critical role of proteinuria in IMN, which was a valuable prognostic indicator for both the clinician and patient. Attaining lower proteinuria predicted good renal survival [15][16][17]. Our data elucidated that, the incidence of remissions of the NS was significantly higher in the TAC group in the initial 3-month follow-up.…”

Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome

“…However, normal renal function was preserved in all No AKI patients with remission of NS. Renal dysfunction and heavy proteinuria have been identified as the risk factors for progression to ESRD in iMN patients in many studies [2,19,[25][26][27], which did not differentiate acute from chronic renal dysfunction. Our study found AKI was a stronger predictor of primary renal endpoint by univariate and multivariate Cox regression analysis.…”

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

“…Wang et al found high expressed miR-193a, and low expressed Wilms tumor type 1 or podocalyxin was associated with poor prognosis for IMN, including elevated proteinuria or serum creatinine, and reduced glomerular filtration rate [36]. Moreover, the baseline proteinuria level in IMN patients is significantly associated with the prognosis, and high proteinuria level with poor prognosis for IMN patients [37]. Finally, the results of this study were restricted in a resource-limited environments, and additional novel treatment strategies should be further explored for improving the prognosis of IMN.…”