Clinical characteristics and prognosis of patients with idiopathic membranous nephropathy with kidney tubulointerstitial damage

Abstract Background To investigate the clinical and kidney pathological features and prognosis of idiopathic membranous nephropathy (IMN) with kidney tubulointerstitial damage (TID). Methods Based on the presence or absence of kidney TID by kidney biopsy, 300 patients diagnosed with IMN were categorized into non-TID (TID−) and tubulointerstitial injury (TID+) groups. The clinical and pathological data were analyzed retrospectively. All patients were followed up for 6–24 months after treatment with glucocorticoids (GCs) combined with cyclophosphamide or GCs combined with calcineurin inhibitors (CNIs) to observe treatment effects on patient prognosis. Results The patients in the TID + group were older and more likely to be male. The 24-h urine protein, blood urea nitrogen, serum creatinine, cystatin C, β2-microglobulin, and antiphospholipase A2 receptor antibody levels were higher than those in the TID − group and the pathological manifestations were more severe. After 1 year of follow-up, the overall response rate (complete response + partial response) in the TID + group was lower (66.67% vs. 80.89%, p = .022) than in the other. After combined GC and CNI therapy, the complete remission rate in the TID + group was significantly lower than that in the TID − group (13.79% vs. 35.46%, p = .022). The 24-h urine protein level was an independent risk factor for worsening kidney condition (p = .038). Conclusion Patients with IMN with TID have more severe clinical manifestations and pathological damage and lower remission rates. IMN with TID is a risk factor for worsening kidney condition; however, it is not an independent risk factor.

[1]  Nan Ye,et al.  Clinicopathologic characteristic and prognosis in idiopathic membranous nephropathy patients with focal segmental sclerosis lesion , 2021, Medicine.

[2]  Yan Zhang,et al.  Retrospective study: clinicopathological features and prognosis of idiopathic membranous nephropathy with seronegative anti-phospholipase A2 receptor antibody , 2020, PeerJ.

[3]  Ying Xu,et al.  Clinical and pathological features of idiopathic membranous nephropathy with focal segmental sclerosis , 2019, BMC Nephrology.

[4]  Jin Zhang,et al.  Urine markers of renal tubular injury in idiopathic membranous nephropathy: A cross sectional study. , 2019, Clinica chimica acta; international journal of clinical chemistry.

[5]  L. Lv,et al.  Renal tubule injury: a driving force toward chronic kidney disease. , 2018, Kidney international.

[6]  V. Jha,et al.  Primary membranous nephropathy in adolescence: A prospective study , 2017, Nephrology.

[7]  W. Couser Primary Membranous Nephropathy. , 2017, Clinical journal of the American Society of Nephrology : CJASN.

[8]  S. Karnik,et al.  Clinicopathological Analysis of Glomerular Disease of Adult Onset Nephrotic Syndrome in an Indian Cohort- A Retrospective Study. , 2017, Journal of clinical and diagnostic research : JCDR.

[9]  Issue Information , 2017 .

[10]  Bo Zhang,et al.  Analysis of the prognostic risk factors of idiopathic membranous nephropathy using a new surrogate end-point , 2015, Biomedical reports.

[11]  G. Mircescu,et al.  Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy , 2015, BioMed research international.

[12]  H. Debiec,et al.  Pathophysiological advances in membranous nephropathy: time for a shift in patient's care , 2015, The Lancet.

[13]  Xiangmei Chen,et al.  Pathological predictors of renal outcomes in nephrotic idiopathic membranous nephropathy with decreased renal function , 2014, JN. Journal of Nephrology (Milano. 1992).

[14]  C. Zeng,et al.  Long-term outcome and prognostic factors of idiopathic membranous nephropathy in the Chinese population. , 2013, Clinical nephrology.

[15]  N. Chen,et al.  Tacrolimus combined with corticosteroids in idiopathic membranous nephropathy: a randomized, prospective, controlled trial. , 2013, Contributions to nephrology.

[16]  Jai Radhakrishnan,et al.  Notice , 2012, Kidney International Supplements.

[17]  B. Kasiske,et al.  KDIGO Clinical Practice Guideline for Glomerulonephritis , 2012 .

[18]  David M. Beck,et al.  Anti-Phospholipase A2 Receptor Antibodies Correlate with Clinical Status in Idiopathic Membranous Nephropathy , 2011 .

[19]  T. Taguchi,et al.  [Pathology of membranous nephropathy]. , 2011, Nihon Jinzo Gakkai shi.

[20]  G. Fernández-Juárez,et al.  Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. , 2010, Journal of the American Society of Nephrology : JASN.

[21]  S. Agarwal,et al.  Focal segmental glomerulosclerosis in idiopathic membranous glomerulonephritis: a clinico-pathological and stereological study. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  K. Sud,et al.  A randomized, controlled trial of steroids and cyclophosphamide in adults with nephrotic syndrome caused by idiopathic membranous nephropathy. , 2007, Journal of the American Society of Nephrology : JASN.

[23]  J. Scholey,et al.  Idiopathic membranous nephropathy: definition and relevance of a partial remission. , 2004, Kidney international.

[24]  N. Yorioka,et al.  Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan. , 2004, Kidney international.

[25]  D. Cattran,et al.  Prognosis after a complete remission in adult patients with idiopathic membranous nephropathy. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[26]  Joseph V. Bonventre,et al.  Kidney Injury Molecule-1 (KIM-1), a Putative Epithelial Cell Adhesion Molecule Containing a Novel Immunoglobulin Domain, Is Up-regulated in Renal Cells after Injury* , 1998, The Journal of Biological Chemistry.

[27]  M. Mihatsch,et al.  Risk factors for cyclosporine-induced nephropathy in patients with autoimmune diseases. International Kidney Biopsy Registry of Cyclosporine in Autoimmune Diseases. , 1992, The New England journal of medicine.

[28]  R. Bader,et al.  Correlations between renal cortical interstitial fibrosis, atrophy of the proximal tubules and impairment of the glomerular filtration rate. , 1981, Clinical nephrology.

[29]  S. Mackensen,et al.  The role of the interstitium of the renal cortex in renal disease. , 1979, Contributions to nephrology.

[30]  H. D. de Wardener,et al.  Relationship between renal function and histological changes found in renal-biopsy specimens from patients with persistent glomerular nephritis. , 1968, Lancet.