Glomerulosclerosis predicts poor renal outcome in patients with idiopathic membranous nephropathy

Abstract

Objective This study aimed to investigate the association between the proportion of glomerulosclerosis (focal segmental glomerulosclerosis and/or global glomerulosclerosis) and renal prognosis in patients with idiopathic membranous nephropathy (IMN). Methods A retrospective analysis performed from January 2008 to December 2017 in the First Affiliated Hospital of Shenzhen University by renal biopsy confirmed 200 patients with IMN, and their clinical pathology and prognosis were compared. Patients were divided into three groups on the basis of glomerular sclerosis proportion tertiles: low (Tertile1 group, proportion of glomerulosclerosis, 0–0%), middle (Tertile2 group, proportion of glomerulosclerosis, 0–5.5%) and high (Tertile3 group, proportion of glomerulosclerosis, 5.8–72.7%) tertiles. The follow-up endpoints were decreased estimated glomerular filtration rate (eGFR) by 20%, end-stage renal disease, and all-cause mortality. Results (1) Both, the Tertile1 and Tertile2, groups had significantly lower albumin level and higher 24-h urine protein level than that in the Tertile3 group. Regarding treatment, as the proportion of glomerulosclerosis increases, a more aggressive treatment with glucocorticoids and immunosuppressants should be provided. (2) Correlation analysis showed that the proportion of glomerulosclerosis was positively associated with age (P < 0.05). However, it was negatively associated with eGFR (P < 0.05). (3) Renal tubular atrophy and renal interstitial inflammatory cell infiltration were considered independent correlative factors for glomerulosclerosis. Kaplan–Meier analysis revealed that renal survival rate was significantly lower in patients with a proportion of glomerulosclerosis ≥ 6.45% than in patients with a proportion of glomerulosclerosis < 6.45%. Cox regression analysis revealed that as the proportion of glomerulosclerosis increases, the risk of renal outcomes increases gradually. Conclusions Patients in the Tertile3 (higher proportion of glomerulosclerosis) group had more severe renal pathological damage compared to patients in the Tertile1 and Tertile2 groups. Glomerulosclerosis is a risk factor for renal function progression and poor renal prognosis in patients with IMN. As the proportion of glomerulosclerosis increases, the risk of renal endpoint events increases gradually.

Glomerulosclerosis is a prognostic risk factor in patients with membranous nephropathy and non-nephrotic proteinuria

“…It is characterized by decreased glomerular endothelial cells, the accumulation of mesangial matrix, the proliferation of podocytes, and the thickening of the basement membrane. It is an important pathological basis for ESRD and the outcome event of almost all chronic renal disease progression [ 11 ]. Previous studies have shown that the deposition of subcutaneous immune complexes on the glomerulus may damage the attachment of podocytes and the basement membrane, and the exfoliation of epithelial cells and the basement membrane may lead to GS [ 9 ].…”

“…Since then, numerous studies have demonstrated that focal segmental glomerulosclerosis (FSGS) disease was a risk factor for poor prognosis in patients with MN [ 9 , 10 ]. Moreover, a Chinese study showed that GS can predict the poor prognosis of primary MN [ 11 ]. However, there have been few cohort studies on patients with MN with NNP.…”

Correlation of Body Mass Index with Clinicopathologic Parameters in Patients with Idiopathic Membranous Nephropathy

“…About 20% of the patients with IMN progress to end-stage renal disease (ESRD) gradually within 5-15 years. 9 M-type phospholipase A2 receptor (m-PLA2R) has been considered to be the major autoantigen of IMN. The Anti-PLA2R antibody has been defined as a suitable biomarker in clinical practice because of its close association with clinical parameters.…”

“…Persistent elevation of anti-PLA2R antibody levels after effective treatment is a significant predictor of poor prognosis. 8,9 However, whether anti-PLA2R has a relationship with histopathological parameters or BMI has not been proved so far.…”

“…Glomerulosclerosis in IMN is closely associated with the patient's prognosis. 9 A retrospective analysis of a large cohort revealed that focal segmental glomerulosclerosis superimposed on MN has been defined as an indicator of poor prognosis. 8 In addition, several studies have reported that chronic tubulointerstitial injuries are independent predictors of progressive renal diseases.…”