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Pathological predictors of renal outcomes in nephrotic idiopathic membranous nephropathy with decreased renal function

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Abstract

Background and objectives

The outcome of idiopathic membranous nephropathy (IMN) in adults with nephrotic-range proteinuria and decreased renal function has seldom been described and the predictive value of pathological features is debated. This study aimed to describe the clinical course of this patient subgroup and to identify independently predictive pathological features.

Materials and methods

We evaluated 129 adults with biopsy-proven IMN diagnosed from 2002 to 2011. All patients had chronic kidney disease (CKD) stages 2–4 and nephrotic-range proteinuria (≥3.5 g/day). Primary outcomes were a 20 or 50 % decline in renal function, progression to end-stage renal disease (ESRD), or all-cause mortality.

Results

Of 129 patients, 38 (30 %) presented with proteinuria ≥8.0 g/day and 37 (29 %) with CKD stages 3–4. Thirteen (10 %) presented with segmental sclerosis, 97 (75 %) with arteriosclerosis, 42 (33 %) with moderate-to-severe tubulointerstitial injury, and 86 (67 %) with C3 deposition. Over a median follow-up of 34 months (range 12–135), 51 patients (40 %) had a 20 % decline in renal function, 27 (21 %) a 50 % decline, 14 (11 %) developed ESRD, and 19 (15 %) died. Segmental sclerosis and tubulointerstitial injury but not arteriosclerosis or C3 deposition were independent risk factors for 20 and 50 % renal function decline and progression to ESRD.

Conclusions

Segmental sclerosis and tubulointerstitial injury predict renal outcomes independent of clinical data in nephrotic IMN patients with decreased renal function.

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Acknowledgments

This work was partially supported by the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2011BAI10B00, 2011BAI10B03), the National Science and Technology Department 863 Project (2012AA02A512), the Beijing Science and Technology Project (D13110700470000), the Health Sector Special Research Project (201002010), and the Consulting Research Project of the Chinese Engineering Academy in 2012 (2012-XY-19). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

All authors declare no competing interests.

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Authors and Affiliations

  1. Division of Nephrology, State Key Discipline of Internal Medicine (Nephrology), State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Medical Research Center for Kidney Disease (2013BAI09B05), Medical Quality Control Center for Kidney Disease, Chinese People’s Liberation Army (PLA) General Hospital (301 Hospital), Chinese PLA Medical Academy, 28 Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China

    Yizhi Chen, Li Tang, Zhe Feng, Xueying Cao, Xuefeng Sun, Moyan Liu, Shuwen Liu, Xueguang Zhang, Ping Li, Ribao Wei, Qiang Qiu, Guangyan Cai & Xiangmei Chen

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  1. Yizhi Chen
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  2. Li Tang
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  3. Zhe Feng
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  12. Guangyan Cai
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  13. Xiangmei Chen
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Corresponding authors

Correspondence to Guangyan Cai or Xiangmei Chen.

Additional information

Y. Chen and L. Tang contributed equally to this work.

This work was published as a POSTER in the American Society of Nephrology (ASN) Kidney Week 2013 Annual Meeting, November 7-10 in Atlanta, GA, USA (FR-PO319).

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Chen, Y., Tang, L., Feng, Z. et al. Pathological predictors of renal outcomes in nephrotic idiopathic membranous nephropathy with decreased renal function. J Nephrol 27, 307–316 (2014). https://doi.org/10.1007/s40620-014-0057-0

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  • DOI: https://doi.org/10.1007/s40620-014-0057-0

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