Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan

Sasaki, Hideo; Saito, Takao; Nishitani, Yoshiharu; Mitarai, Tetsuya; Yorioka, Noriaki; Yoshimura, Akinobu; Yokoyama, Hitoshi; Nishi, Shinichi; Tomino, Yasuhiko; Kurokawa, Kiyoshi; Sakai, Hideto

doi:10.1111/j.1523-1755.2004.00518.x

Cited by 161 publications

(168 citation statements)

References 13 publications

(22 reference statements)

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“…The renal survival rate was 60 % at 20 years after diagnosis in patients with primary MN, and the renal survival rate in patients on steroid therapy was significantly higher in patients on supportive therapy alone in Japan [16], while spontaneous remission was reported to be common (32 %) in patients with primary MN with nephrotic syndrome in Spain [17], even in patients exhibiting chronic renal impairment [18]. Whether treatment with renin-angiotensin blockers or immunoglobulins other than steroids has a favorable effect on the renal prognosis of primary MN should be elucidated in future clinical studies.…”

Section: Discussion and Commentsmentioning

confidence: 95%

“…Since MCNS develops in patients at younger ages [5,15] while primary MN develops in a relatively elderly population [15,16], the frequency of these diseases may depend on the distribution of the age ranges of patients registered in each year. Indeed, the rate of native biopsies of subjects younger than 20 years of age slightly increased from 11.4 % in 2009 to 12.7 % in 2010 (Table 3) and the mean age of patients with nephrotic syndrome slightly decreased from 53.5 years in 2009 to 50.1 years in 2010 (Table 5) in the J-RBR.…”

Section: Discussion and Commentsmentioning

confidence: 99%

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Japan Renal Biopsy Registry and Japan Kidney Disease Registry: Committee Report for 2009 and 2010

et al. 2013

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123Clin Exp Nephrol (2013) 17:155-173 DOI 10.1007 nephritic syndrome (55.4 % and 50.0 % in 2009 and 2010, respectively), followed by nephrotic syndrome (22.4 % and 27.0 %); the most frequent pathological diagnosis as classified by the pathogenesis was IgA nephropathy (31.6 % and 30.4 %), followed by primary glomerular diseases (except IgA nephropathy) (27.2 % and 28.1 %). Among the primary glomerular diseases (except IgA nephropathy) in the patients with nephrotic syndrome, membranous nephropathy was the most common histopathology in 2009 (40.3 %) and minor glomerular abnormalities (50.0 %) were the most common in 2010 in native kidneys in the J-RBR. Five new secondary and longitudinal research studies by the J-KDR were started in 2009 and one was started in 2010.

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Section: Discussion and Commentsmentioning

confidence: 95%

Section: Discussion and Commentsmentioning

confidence: 99%

Japan Renal Biopsy Registry and Japan Kidney Disease Registry: Committee Report for 2009 and 2010

et al. 2013

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“…Prednisolone, either alone or combined with an immunosuppressive drug, seems to be useful in Japanese patients. Indeed, steroid therapy is effective not only in inducing a remission of nephrotic syndrome but also in preserving renal function [4]. However, Hogan et al [5] demonstrated a lower 5-year renal survival rate in the steroid/no-therapy group than in patients receiving the steroid and alkylating agents.…”

Section: Discussionmentioning

confidence: 99%

Partial remission by cyclosporine monotherapy in a patient with membranous nephropathy superimposed diabetic nephropathy

et al. 2016

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It has been noted that cyclosporine A (CsA) is an effective drug for membranous nephropathy (MN). Diabetes is a common disease that sometimes causes nephrotic syndrome. We report the case of an 89-year-old woman with type 2 diabetes mellitus who exhibited nephrotic syndrome. Examination of a renal biopsy indicated MN and she was prescribed CsA as monotherapy. Her edema subsided and she achieved partial remission. This is the first report of a patient in diabetic condition with MN having achieved partial remission after CsA monotherapy without steroid therapy. The use of steroid in patients with diabetes may worsen their diabetic condition, especially if they are of very advanced age. CsA monotherapy may be useful for diabetic patients with MN.

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“…A recent study demonstrates enhanced staining of PLA2R in glomeruli in cases with idiopathic MGN compared with negative staining in secondary MGN [9]. On the other hand, secondary MGN accounts for about 10-20 % of MGN, and causative antigens reported were drugs, tumor associated antigens such as CEA and cytokeratin 19 fragment, Hepatitis B virus, envelope antigen, and the other antigens in autoimmune diseases [6,7]. In the present case, three possible causes of MGN were considered; coincidence of idiopathic MGN, MGN associated with pulmonary adenocarcinoma or gefitinib treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The deposition of IgA and C3 was also found mainly in the mesangial areas. The expression of phospholipase A2 receptor (PLA2R), which is considered as the antigen of primary MGN [6,7], did not enhance in glomeruli, although it was enhanced on glomerular capillaries in some cases of primary MGN (data not shown). As electron microscopic findings, granular electron dense deposit was found irregularly at the subepithelial region on the glomerular basement membrane (GBM) (Fig.…”

Section: Case Reportmentioning

confidence: 96%

A case of gefitinib-associated membranous nephropathy in treatment for pulmonary adenocarcinoma

et al. 2014

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We experienced a case that was considered as gefitinib-associated membranous nephropathy (MGN) in treatment for pulmonary adenocarcinoma. A female patient aged 80 who had been treated for lung cancer was referred and hospitalized at our hospital, because of nephrotic syndrome. The patient had pulmonary adenocarcinoma (cT4N2M1a) with positive for epidermal growth factor receptor (EGFR) mutation. Gefitinib, EGFR tyrosine kinase inhibitor, was initiated from 1 year and 2 months ago. At that time, proteinuria was negative. The treatment effect on lung cancer was so favorable that partial response had been maintained. However, from 4 months ago, edema of legs appeared, leading to become nephrotic syndrome. Renal biopsy was performed, and secondary MGN was diagnosed, because of deposition of peripheral IgG, mesangial IgA, and C3, as well as the deposition of peripheral IgG4, IgG1, IgG2, and weak IgG3. We considered druginduced MGN and discontinued the administration of gefitinib. Subsequently, the proteinuria tended to decrease gradually and became negative 10 months later. However, the lung cancer recurred 3 months after discontinuation of gefitinib and another molecular target drug, erlotinib, was administered. At present, 13 months after discontinuation of gefitinib, absence of proteinuria is maintained. It has been generally considered that secondary MGN can be induced by both malignant tumor and their treatment. In the present case, the clinical course and pathological characteristics showed the secondary MGN that might be associated with gefitinib during the treatment for pulmonary adenocarcinoma. The present case, to our knowledge, may be a first case of gefitinib-associated MGN.

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Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan

Cited by 161 publications

References 13 publications

Japan Renal Biopsy Registry and Japan Kidney Disease Registry: Committee Report for 2009 and 2010

Japan Renal Biopsy Registry and Japan Kidney Disease Registry: Committee Report for 2009 and 2010

Partial remission by cyclosporine monotherapy in a patient with membranous nephropathy superimposed diabetic nephropathy

A case of gefitinib-associated membranous nephropathy in treatment for pulmonary adenocarcinoma

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