Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

Abstract

Pure MLN frequently presents with nephrotic syndrome, high proteinuria and normal serum creatinine. Its prognosis is favourable in maintaining renal function although proteinuria usually persists over time. Baseline cardiovascular disease and not having a health insurance are related with poor prognosis.

Outcomes of membranous and proliferative lupus nephritis – analysis of a single-centre cohort with more than 30 years of follow-up

“…Although most studies suggest baseline proteinuria and serum creatinine as predictors of prognosis [ 8 , 28–31 ], several other studies, like ours, support the importance of renal parameters at 12 months [ 6 , 35 , 36 ]. Dall’Era et al looking at long-term outcomes in 76 patients of the Euro-Lupus Nephritis Cohort, found proteinuria below 0.8 g/day, 12 months after beginning treatment, to be the single best predictor of good long-term renal function (sensitivity 81% and specificity 78%) [ 6 ].…”

“…1 are true for PLN, we do not have enough data to confirm their validity for pure MLN. However, a recent retrospective multicentre study by Silva-Fernandez et al analysed the outcome of 150 patients with pure MLN from Spain and the US (65% Caucasians), with a mean follow up of 7.6 years [ 8 ]. By the end of follow-up, eight patients (5.3%) had developed ESRD and nine patients (6%) had died.…”

“…Predictors of death in the study by Silva-Fernandez et al [ 8 ] included age, haemodialysis and not having received mycophenolate mofetil or antimalarials. We found both age at diagnosis and the absence of treatment with antimalarials to be associated with death, on univariable analysis.…”

“…However, the effect was not significant after adjusting for eGFR. Several other studies mention the protective role of antimalarials in patients with LN [ 8 , 31 ]. We did not analyse the effect of each individual immunosuppressant separately, but did not find a significant effect from the use of immunosuppressants as a whole.…”

“…There are several studies analysing the long-term outcomes of patients with PLN [ 5–7 ], MLN [ 8–10 ], and even comparing pure PLN or pure MLN with mixed LN [ 11–13 ]. However, to our knowledge there are no recent studies directly comparing the very long-term outcomes of PLN vs MLN.…”