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Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium
BACKGROUND: Idiopathic membranous nephropathy (MN) is one of the leading causes of nephrotic syndrome in adults and may result in end-stage renal disease (ESRD). In this retrospective study, we describe the outcomes and treatment patterns of patients with idiopathic MN in six nephrology clinics in t...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792626/ https://www.ncbi.nlm.nih.gov/pubmed/26985373 http://dx.doi.org/10.1093/ckj/sfv152 |
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author | Lönnbro-Widgren, Jennie Mölne, Johan Haraldsson, Börje Nyström, Jenny |
author_facet | Lönnbro-Widgren, Jennie Mölne, Johan Haraldsson, Börje Nyström, Jenny |
author_sort | Lönnbro-Widgren, Jennie |
collection | PubMed |
description | BACKGROUND: Idiopathic membranous nephropathy (MN) is one of the leading causes of nephrotic syndrome in adults and may result in end-stage renal disease (ESRD). In this retrospective study, we describe the outcomes and treatment patterns of patients with idiopathic MN in six nephrology clinics in the western part of Sweden. METHODS: Seventy-three consecutive patients with biopsy-proven MN in the years 2000–12 were classified as idiopathic, i.e. secondary forms were excluded. The patients were followed retrospectively for a mean period of 83 months and clinical data were collected through the medical files. RESULTS: A high proportion (88%) of the patients received supportive treatment with angiotensin-converting enzyme inhibition, angiotensin receptor blockade and/or statins. At the end of follow-up, 43 patients were in complete remission, 12 in partial remission, 10 patients had developed ESRD and 8 patients had on-going proteinuria. Fifty-one per cent of the patients received immunosuppressive therapy and the choice of therapy varied between and within the clinics. There was a tendency to initiate specific treatment at an early point instead of awaiting a possible spontaneous remission (21% of the patients), and non-recommended therapy such as corticosteroids only was used in a high proportion of these cases (47%). CONCLUSIONS: Even though the treatment recommendations in idiopathic MN have not changed the last decade, the question of whom and when to treat seems to lead to uncertainty. Recent studies have presented promising results supporting the PLA(2)R antibody the predictive marker needed for this patient group. The diverse treatment approach presented in this study might have resulted in a worse outcome than expected. Hopefully, unnecessary exposure to immunosuppressive therapy or delayed treatment can be avoided through better support, education and treatment forums, and thus result in an improved outcome. |
format | Online Article Text |
id | pubmed-4792626 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-47926262016-03-16 Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium Lönnbro-Widgren, Jennie Mölne, Johan Haraldsson, Börje Nyström, Jenny Clin Kidney J Glomerulonephritis BACKGROUND: Idiopathic membranous nephropathy (MN) is one of the leading causes of nephrotic syndrome in adults and may result in end-stage renal disease (ESRD). In this retrospective study, we describe the outcomes and treatment patterns of patients with idiopathic MN in six nephrology clinics in the western part of Sweden. METHODS: Seventy-three consecutive patients with biopsy-proven MN in the years 2000–12 were classified as idiopathic, i.e. secondary forms were excluded. The patients were followed retrospectively for a mean period of 83 months and clinical data were collected through the medical files. RESULTS: A high proportion (88%) of the patients received supportive treatment with angiotensin-converting enzyme inhibition, angiotensin receptor blockade and/or statins. At the end of follow-up, 43 patients were in complete remission, 12 in partial remission, 10 patients had developed ESRD and 8 patients had on-going proteinuria. Fifty-one per cent of the patients received immunosuppressive therapy and the choice of therapy varied between and within the clinics. There was a tendency to initiate specific treatment at an early point instead of awaiting a possible spontaneous remission (21% of the patients), and non-recommended therapy such as corticosteroids only was used in a high proportion of these cases (47%). CONCLUSIONS: Even though the treatment recommendations in idiopathic MN have not changed the last decade, the question of whom and when to treat seems to lead to uncertainty. Recent studies have presented promising results supporting the PLA(2)R antibody the predictive marker needed for this patient group. The diverse treatment approach presented in this study might have resulted in a worse outcome than expected. Hopefully, unnecessary exposure to immunosuppressive therapy or delayed treatment can be avoided through better support, education and treatment forums, and thus result in an improved outcome. Oxford University Press 2016-04 2016-01-27 /pmc/articles/PMC4792626/ /pubmed/26985373 http://dx.doi.org/10.1093/ckj/sfv152 Text en © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Glomerulonephritis Lönnbro-Widgren, Jennie Mölne, Johan Haraldsson, Börje Nyström, Jenny Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium |
title | Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium |
title_full | Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium |
title_fullStr | Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium |
title_full_unstemmed | Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium |
title_short | Treatment pattern in patients with idiopathic membranous nephropathy—practices in Sweden at the start of the millennium |
title_sort | treatment pattern in patients with idiopathic membranous nephropathy—practices in sweden at the start of the millennium |
topic | Glomerulonephritis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792626/ https://www.ncbi.nlm.nih.gov/pubmed/26985373 http://dx.doi.org/10.1093/ckj/sfv152 |
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