Clinical implications of pathological features of primary membranous nephropathy
Abstract Background The clinical outcome varies considerably in primary membranous nephropathy (pMN). Risk factors for kidney prognosis include ageing, male gender, persistent heavy proteinuria, decreased eGFR at presentation, persistent elevation of anti-PLA2R antibodies, no remission, and so on. I...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-08-01
|
| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-018-1011-5 |
| _version_ | 1830402446259650560 |
|---|---|
| author | Xiao-dan Zhang Zhao Cui Mu-fan Zhang Jia Wang Yi-miao Zhang Zhen Qu Xin Wang Jing Huang Fang Wang Li-qiang Meng Xu-yang Cheng Su-xia Wang Gang Liu Ming-hui Zhao |
| author_facet | Xiao-dan Zhang Zhao Cui Mu-fan Zhang Jia Wang Yi-miao Zhang Zhen Qu Xin Wang Jing Huang Fang Wang Li-qiang Meng Xu-yang Cheng Su-xia Wang Gang Liu Ming-hui Zhao |
| author_sort | Xiao-dan Zhang |
| collection | DOAJ |
| description | Abstract Background The clinical outcome varies considerably in primary membranous nephropathy (pMN). Risk factors for kidney prognosis include ageing, male gender, persistent heavy proteinuria, decreased eGFR at presentation, persistent elevation of anti-PLA2R antibodies, no remission, and so on. It was controversial whether the histopathological features of pMN could predict treatment response and kidney outcome. Methods A retrospective study was conducted in 371 patients with biopsy-proven pMN. Pathological parameters included immunofluorescence staining, membranous Churg’s stages, sclerosis, crescent, focal segmental sclerosis lesion, chronic and acute tubulointerstitial injury. The fluorescence intensity was determined: 0, negative; 1, weak; 2, moderate; 3, strong; 4, glaring. Chronic tubulointerstitial injury was graded by the involved area: 0, 0–5%; 1, 6–25%; 2, 26–50%; 3, > 50%. Results We found that patients with higher intensity of C3 staining, advanced membranous stage, and more severe chronic tubulointerstitial injury presented with higher positivity rate of anti-PLA2R antibodies, higher levels of urinary protein excretion and serum creatinine, and lower level of serum albumin. Univariate Cox regression analysis showed that severe (grade = 3) chronic tubulointerstitial injury was a risk factor to the kidney outcome of ESKD (HR = 61.02, 95%CI, 7.75–480.57, P < 0.001) and over 50% reduction of eGFR (HR = 4.43, 95%CI, 1.26–15.6, P = 0.021). Multivariate analysis demonstrated it as an independent risk factor to ESKD (HR = 25.77, 95% CI, 1.27–523.91, P = 0.035). None of the pathological parameters exerted any influence on treatment response (P > 0.05). Conclusions We found the prognostic role of chronic tubulointerstitial injury to the kidney outcome of pMN. This study highlighted the value of kidney biopsy under the widespread usage of anti-PLA2R antibodies for diagnosis and prognosis. |
| first_indexed | 2024-12-20T16:54:19Z |
| format | Article |
| id | doaj.art-cfcf12643eeb4d01a14fd97a9112c884 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-20T16:54:19Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-cfcf12643eeb4d01a14fd97a9112c8842022-12-21T19:32:46ZengBMCBMC Nephrology1471-23692018-08-011911910.1186/s12882-018-1011-5Clinical implications of pathological features of primary membranous nephropathyXiao-dan Zhang0Zhao Cui1Mu-fan Zhang2Jia Wang3Yi-miao Zhang4Zhen Qu5Xin Wang6Jing Huang7Fang Wang8Li-qiang Meng9Xu-yang Cheng10Su-xia Wang11Gang Liu12Ming-hui Zhao13Renal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityLaboratory of Electron Microscopy, Pathological Centre, Peking University First HospitalRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityRenal Division, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking University First Hospital, Institute of Nephrology, Peking UniversityAbstract Background The clinical outcome varies considerably in primary membranous nephropathy (pMN). Risk factors for kidney prognosis include ageing, male gender, persistent heavy proteinuria, decreased eGFR at presentation, persistent elevation of anti-PLA2R antibodies, no remission, and so on. It was controversial whether the histopathological features of pMN could predict treatment response and kidney outcome. Methods A retrospective study was conducted in 371 patients with biopsy-proven pMN. Pathological parameters included immunofluorescence staining, membranous Churg’s stages, sclerosis, crescent, focal segmental sclerosis lesion, chronic and acute tubulointerstitial injury. The fluorescence intensity was determined: 0, negative; 1, weak; 2, moderate; 3, strong; 4, glaring. Chronic tubulointerstitial injury was graded by the involved area: 0, 0–5%; 1, 6–25%; 2, 26–50%; 3, > 50%. Results We found that patients with higher intensity of C3 staining, advanced membranous stage, and more severe chronic tubulointerstitial injury presented with higher positivity rate of anti-PLA2R antibodies, higher levels of urinary protein excretion and serum creatinine, and lower level of serum albumin. Univariate Cox regression analysis showed that severe (grade = 3) chronic tubulointerstitial injury was a risk factor to the kidney outcome of ESKD (HR = 61.02, 95%CI, 7.75–480.57, P < 0.001) and over 50% reduction of eGFR (HR = 4.43, 95%CI, 1.26–15.6, P = 0.021). Multivariate analysis demonstrated it as an independent risk factor to ESKD (HR = 25.77, 95% CI, 1.27–523.91, P = 0.035). None of the pathological parameters exerted any influence on treatment response (P > 0.05). Conclusions We found the prognostic role of chronic tubulointerstitial injury to the kidney outcome of pMN. This study highlighted the value of kidney biopsy under the widespread usage of anti-PLA2R antibodies for diagnosis and prognosis.http://link.springer.com/article/10.1186/s12882-018-1011-5Membranous nephropathyPathologyTubulointerstitial injuryPrognosis |
| spellingShingle | Xiao-dan Zhang Zhao Cui Mu-fan Zhang Jia Wang Yi-miao Zhang Zhen Qu Xin Wang Jing Huang Fang Wang Li-qiang Meng Xu-yang Cheng Su-xia Wang Gang Liu Ming-hui Zhao Clinical implications of pathological features of primary membranous nephropathy BMC Nephrology Membranous nephropathy Pathology Tubulointerstitial injury Prognosis |
| title | Clinical implications of pathological features of primary membranous nephropathy |
| title_full | Clinical implications of pathological features of primary membranous nephropathy |
| title_fullStr | Clinical implications of pathological features of primary membranous nephropathy |
| title_full_unstemmed | Clinical implications of pathological features of primary membranous nephropathy |
| title_short | Clinical implications of pathological features of primary membranous nephropathy |
| title_sort | clinical implications of pathological features of primary membranous nephropathy |
| topic | Membranous nephropathy Pathology Tubulointerstitial injury Prognosis |
| url | http://link.springer.com/article/10.1186/s12882-018-1011-5 |
| work_keys_str_mv | AT xiaodanzhang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT zhaocui clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT mufanzhang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT jiawang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT yimiaozhang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT zhenqu clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT xinwang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT jinghuang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT fangwang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT liqiangmeng clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT xuyangcheng clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT suxiawang clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT gangliu clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy AT minghuizhao clinicalimplicationsofpathologicalfeaturesofprimarymembranousnephropathy |