A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
<h4>Introduction</h4> Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportiv...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9560622/?tool=EBI |
| _version_ | 1828141941166964736 |
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| author | Joshua Storrar Tarra Gill-Taylor Rajkumar Chinnadurai Constantina Chrysochou Dimitrios Poulikakos Francesco Rainone James Ritchie Elizabeth Lamerton Philip A. Kalra Smeeta Sinha |
| author_facet | Joshua Storrar Tarra Gill-Taylor Rajkumar Chinnadurai Constantina Chrysochou Dimitrios Poulikakos Francesco Rainone James Ritchie Elizabeth Lamerton Philip A. Kalra Smeeta Sinha |
| author_sort | Joshua Storrar |
| collection | DOAJ |
| description | <h4>Introduction</h4> Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. <h4>Methods</h4> 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. <h4>Results</h4> Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. <h4>Conclusion</h4> We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress. |
| first_indexed | 2024-04-11T19:33:14Z |
| format | Article |
| id | doaj.art-a8357328240f4d158dba6764c9fc1d46 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-11T19:33:14Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a8357328240f4d158dba6764c9fc1d462022-12-22T04:06:56ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-011710A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decadesJoshua StorrarTarra Gill-TaylorRajkumar ChinnaduraiConstantina ChrysochouDimitrios PoulikakosFrancesco RainoneJames RitchieElizabeth LamertonPhilip A. KalraSmeeta Sinha<h4>Introduction</h4> Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. <h4>Methods</h4> 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. <h4>Results</h4> Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. <h4>Conclusion</h4> We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9560622/?tool=EBI |
| spellingShingle | Joshua Storrar Tarra Gill-Taylor Rajkumar Chinnadurai Constantina Chrysochou Dimitrios Poulikakos Francesco Rainone James Ritchie Elizabeth Lamerton Philip A. Kalra Smeeta Sinha A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades PLoS ONE |
| title | A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades |
| title_full | A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades |
| title_fullStr | A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades |
| title_full_unstemmed | A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades |
| title_short | A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades |
| title_sort | low rate of end stage kidney disease in membranous nephropathy a single centre study over 2 decades |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9560622/?tool=EBI |
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