Cargando…

A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades

INTRODUCTION: Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immu...

Descripción completa

Detalles Bibliográficos
Autores principales: Storrar, Joshua, Gill-Taylor, Tarra, Chinnadurai, Rajkumar, Chrysochou, Constantina, Poulikakos, Dimitrios, Rainone, Francesco, Ritchie, James, Lamerton, Elizabeth, Kalra, Philip A., Sinha, Smeeta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9560622/
https://www.ncbi.nlm.nih.gov/pubmed/36228014
http://dx.doi.org/10.1371/journal.pone.0276053
_version_ 1784807792016621568
author Storrar, Joshua
Gill-Taylor, Tarra
Chinnadurai, Rajkumar
Chrysochou, Constantina
Poulikakos, Dimitrios
Rainone, Francesco
Ritchie, James
Lamerton, Elizabeth
Kalra, Philip A.
Sinha, Smeeta
author_facet Storrar, Joshua
Gill-Taylor, Tarra
Chinnadurai, Rajkumar
Chrysochou, Constantina
Poulikakos, Dimitrios
Rainone, Francesco
Ritchie, James
Lamerton, Elizabeth
Kalra, Philip A.
Sinha, Smeeta
author_sort Storrar, Joshua
collection PubMed
description INTRODUCTION: Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. METHODS: 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. RESULTS: Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. CONCLUSION: We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.
format Online
Article
Text
id pubmed-9560622
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-95606222022-10-14 A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades Storrar, Joshua Gill-Taylor, Tarra Chinnadurai, Rajkumar Chrysochou, Constantina Poulikakos, Dimitrios Rainone, Francesco Ritchie, James Lamerton, Elizabeth Kalra, Philip A. Sinha, Smeeta PLoS One Research Article INTRODUCTION: Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. METHODS: 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. RESULTS: Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. CONCLUSION: We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress. Public Library of Science 2022-10-13 /pmc/articles/PMC9560622/ /pubmed/36228014 http://dx.doi.org/10.1371/journal.pone.0276053 Text en © 2022 Storrar et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Storrar, Joshua
Gill-Taylor, Tarra
Chinnadurai, Rajkumar
Chrysochou, Constantina
Poulikakos, Dimitrios
Rainone, Francesco
Ritchie, James
Lamerton, Elizabeth
Kalra, Philip A.
Sinha, Smeeta
A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
title A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
title_full A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
title_fullStr A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
title_full_unstemmed A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
title_short A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
title_sort low rate of end-stage kidney disease in membranous nephropathy: a single centre study over 2 decades
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9560622/
https://www.ncbi.nlm.nih.gov/pubmed/36228014
http://dx.doi.org/10.1371/journal.pone.0276053
work_keys_str_mv AT storrarjoshua alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT gilltaylortarra alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT chinnadurairajkumar alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT chrysochouconstantina alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT poulikakosdimitrios alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT rainonefrancesco alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT ritchiejames alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT lamertonelizabeth alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT kalraphilipa alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT sinhasmeeta alowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT storrarjoshua lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT gilltaylortarra lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT chinnadurairajkumar lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT chrysochouconstantina lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT poulikakosdimitrios lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT rainonefrancesco lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT ritchiejames lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT lamertonelizabeth lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT kalraphilipa lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades
AT sinhasmeeta lowrateofendstagekidneydiseaseinmembranousnephropathyasinglecentrestudyover2decades