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PREDICTORS OF RENAL SURVIVAL IN PATIENTS WITH IDIOPATHIC MEMBRANOUS NEPHROPATHY Free

INTRODUCTION AND AIMS: Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults. In this multicenter study, we aim to investigate the relationship between histopathological, clinical, and laboratory findings in patients with IMN.

METHODS: Two hundred and eighty-one IMN patients [59.8% male, mean age 45±15 years] from four nephrology clinics were enrolled. The impact of histopathological lesions (glomerular sclerosis, crescents, intensity and pattern of staining for C3 and IgG) and clinical markers [age, gender, systolic and diastolic blood pressure (BP), estimated glomerular filtration rate (eGFR), serum creatinine, hemoglobin (Hgb), albumin, proteinuria, anti-PLA2R antibody] on composite renal outcome [defined as development of end stage renal disease (ESRD) or a >50% decrease in eGFR as compared to baseline levels] were assessed using Cox regression analysis.

RESULTS: Mean levels of systolic and diastolic BP, serum creatinine, albumin, and proteinuria at the time of diagnosis were 130±18 mmHg, 81±11 mmHg, 1.00±0.77 mg/dL, 2.72±0.77 g/dL and 6.20±3.95 g/day, respectively. Composite renal outcome developed in 33 (11.7%) and ESRD developed in 15 (5.3%) patients after a median of 33.5 (IQR: 14-66.6) months. In Cox regression analysis, histological lesions were not associated with progression of IMN. However, systolic BP (B: 1.087, p=0.038), Hgb (B: 0.438, p=0.047) and eGFR (B: 0.917, p=0.011) levels at baseline predicted composite renal outcome.

CONCLUSIONS: Our study shows that progression of IMN and development of ESRD are associated with the presence of clinical risk factors, in particular systolic BP, impaired kidney function and anemia at the time of diagnosis.