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Significance of the total renal chronicity score in predicting renal outcome in PLA2R-associated membranous nephropathy

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Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Phospholipase A2 receptor (PLA2R)-associated membranous nephropathy accounts for the majority of membranous nephropathy; however, few studies have determined the prognostic impact and clinical application of renal pathologic change on this disease.

Methods

A retrospective cohort study of 262 patients with PLA2R-associated membranous nephropathy was conducted. The total renal chronicity score calculated according to the degree of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriosclerosis was applied to evaluate renal chronicity. Baseline bias was adjusted by inverse probability weight when assessing the prognostic impact of chronicity, and multiple parameters were used to evaluate the application value of renal chronicity.

Results

During a median follow-up of 24.5 months, renal outcome (kidney function deterioration and/or end-stage kidney disease) was observed in 22 (8.40%) patients. Not only did a higher total renal chronicity score independently predict renal outcome [odds ratio (OR): 1.562, 95% confidence interval (CI) 1.073–2.273, P = 0.020], but non-minimal chronicity was also an independent risk factor for renal outcome (OR: 3.170, 95% CI 1.040–9.659, P = 0.042). Moreover, the membranous nephropathy risk classification in the Kidney Disease: Improving Global Outcomes (KDIGO) guideline integrated with non-minimal chronicity showed improvements in categorical net reclassification (0.174, 95% CI 0.012–0.335, P = 0.035), continuous net reclassification (0.462, 95% CI 0.087–0.838, P = 0.016), and integrated discrimination (0.019, 95% CI 0.003–0.035, P = 0.020) compared to the original classification.

Conclusions

Renal chronicity is closely associated with renal outcomes in PLA2R-associated membranous nephropathy, and combining the KDIGO risk classification with chronicity scores may provide a more accurate prognostic prediction.

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Data availability

The data that support the findings of this study are available from the corresponding author, [Qi Bian], upon reasonable request.

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Authors and Affiliations

  1. Department of Nephrology, Changhai Hospital, Naval Medical University, Shanghai, China

    Weifu Ren, Jing Sun, Lingyan Zhang, Wei He, Zhiyong Guo & Qi Bian

Authors
  1. Weifu Ren
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  2. Jing Sun
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  3. Lingyan Zhang
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  4. Wei He
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  5. Zhiyong Guo
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  6. Qi Bian
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Contributions

WR, QB, and ZG designed the study. LZ and WH collected the samples and abstracted the data. JS and QB examined and scored the renal biopsies. WR processed the data and performed the statistical analysis. WR, JS, LZ, and WH wrote the original draft; ZG and QB revised and edited the final draft.

Corresponding authors

Correspondence to Zhiyong Guo or Qi Bian.

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Conflict of interest

None declared.

Ethical approval

The study protocol was approved by the Shanghai Changhai Hospital Ethics Committee (CHEC2022-028) and performed as per the Helsinki Declaration. Written informed consent for both the kidney biopsy and participation in the present study was obtained from all patients.

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Ren, W., Sun, J., Zhang, L. et al. Significance of the total renal chronicity score in predicting renal outcome in PLA2R-associated membranous nephropathy. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01893-z

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