The Natural History of the Non-Nephrotic Membranous Nephropathy Patient

Hladunewich, Michelle A.; Troyanov, Stéphan; Calafati, Jennifer; Cattran, Daniel C.

doi:10.2215/cjn.01330209

Cited by 111 publications

(108 citation statements)

References 19 publications

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“…Similar results were published by Marx et al [16] and Yoshimoto et al [30], while Heeringa et al [10] reported serum creatinine as an independent predictor. We found baseline 24-hour proteinuria as an unfavorable predictor for RF in univariate analysis and multivariate analysis, which is consistent with other studies [11,16,30].…”

Section: Discussionsupporting

confidence: 93%

Prognostic significance of glomerular and tubulointerstitial morphometry in idiopathic membranous nephropathy

Horvatić

Ljubanović

Bulimbašić

et al. 2012

Pathology - Research and Practice

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Section: Discussionsupporting

confidence: 93%

Prognostic significance of glomerular and tubulointerstitial morphometry in idiopathic membranous nephropathy

Horvatić

Ljubanović

Bulimbašić

et al. 2012

Pathology - Research and Practice

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“…Some of the previous studies reporting SR in untreated IMN patients included an important number of patients presenting with non-nephrotic proteinuria, 21 a clinical presentation with an inherently good prognosis. 1,13,22 Our study also provides interesting and previously not well characterized features of SR. Confirming previous studies 16 -20 most SR appeared during the first 2 years after diagnosis.…”

Section: Discussionmentioning

confidence: 58%

“…In particular, treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor antagonists (ARBs) in patients with nephrotic syndrome was uncommon, whereas they are now widely prescribed in patients with proteinuric nephropathies. Furthermore, some of the studies reporting SR in untreated IMN patients included an important number of patients presenting with non-nephrotic proteinuria, 21 a clinical presentation with an inherently good prognosis, 22 and recent data about clinical characteristics, predicting factors, and long-term outcome in IMN are scanty. The aim of the present retrospective study was to report the clinical features and outcome of 328 patients with biopsy-proven IMN, in whom an initially conservative therapeutic approach, without corticosteroids or other immunosuppressive agents, was followed.…”

mentioning

confidence: 99%

Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy

Polanco¹,

Gutiérrez²,

Covarsí

et al. 2010

Journal of the American Society of Nephrology

318

202

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Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 Ϯ 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria Ͼ12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a Ͼ50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria Ͼ50% from baseline during the first year predicts spontaneous remission.

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“…The value of adding angiotensin II blockade to a conservative regimen, with the intent of fostering a "spontaneous" remission, is not firmly proven, and little benefit of such treatment is observed in patients presenting with proteinuria .10 g/d (19), but it may augment spontaneous remissions when lower levels of proteinuria are present (20). Conservative management is justified for patients with persistent subnephrotic proteinuria.…”

Section: When Should a Specific Treatment For Idiopathic Mn Be Started?mentioning

confidence: 99%

“…Conservative management is justified for patients with persistent subnephrotic proteinuria. However, these patients should be monitored because approximately 60% of them may progress to nephrotic syndrome (20). Patients with proteinuria persistently (.6 months) .4 g/d have an approximately 55% probability of developing ESRD within 10 years, and those with persisting proteinuria .8 g/d and/or abnormal levels of serum creatinine have an approximately 66%-80% probability of developing ESRD within 10 years (21).…”

Section: When Should a Specific Treatment For Idiopathic Mn Be Started?mentioning

confidence: 99%

Glomerular Diseases

Ponticelli

Glassock

2014

Clinical Journal of the American Society of Nephrology

179

128

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SummaryMembranous nephropathy (MN) is an autoimmune disease usually associated with a nephrotic syndrome and it may progress to ESRD in the long term. Its etiology is often unknown (idiopathic MN), whereas other cases have a recognizable etiology (secondary MN). In idiopathic MN, the glomerular lesions are mainly caused by autoantibodies against a podocyte membrane protein, the M-type of phospholipase A2 receptor 1. The natural course of idiopathic MN is quite varied with spontaneous complete or partial remissions a relatively common occurrence. Patients with asymptomatic non-nephrotic proteinuria seldom progress and need only conservative management. Those with persistent full-blown nephrotic syndrome and those with declining renal function are candidates for specific treatment with any of several regimens. Cyclical therapy with alternating monthly intravenous and oral glucocorticoids combined with a cytotoxic agent can induce remission and preserve renal function in the long term. Cyclosporine or tacrolimus can induce remission, but relapses are frequent after the drug withdrawal. Mycophenolate mofetil monotherapy seems to be ineffective, but may be beneficial when administered together with steroids. The experience with adrenocorticotropic hormone, natural or synthetic, is limited to a few studies with short-term follow-up, but high rates of remission can be seen after prolonged treatment. A high rate of remission and good tolerance have also been reported with rituximab. Patients with moderate renal insufficiency may also benefit from treatment, but at a price of frequent and serious side effects. With these limitations in mind, idiopathic MN may be considered a treatable disease in many patients.

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The Natural History of the Non-Nephrotic Membranous Nephropathy Patient

Cited by 111 publications

References 19 publications

Prognostic significance of glomerular and tubulointerstitial morphometry in idiopathic membranous nephropathy

Prognostic significance of glomerular and tubulointerstitial morphometry in idiopathic membranous nephropathy

Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy

Glomerular Diseases

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