Pathological predictors of renal outcomes in nephrotic idiopathic membranous nephropathy with decreased renal function
| Autor: | Shuwen Liu, Xuefeng Sun, Qiang Qiu, Guangyan Cai, Yizhi Chen, Xueying Cao, Ribao Wei, Li Tang, Li Ping, Xueguang Zhang, Xiangmei Chen, Moyan Liu, Feng Zhe |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Nephrology medicine.medical_specialty Pathology Nephrotic Syndrome Time Factors Biopsy Urology Renal function Kidney urologic and male genital diseases Glomerulonephritis Membranous End stage renal disease Membranous nephropathy Predictive Value of Tests Risk Factors Internal medicine medicine Humans Renal Insufficiency Chronic Aged Retrospective Studies Sclerosis Proteinuria business.industry Glomerulonephritis Middle Aged medicine.disease Predictive value of tests Disease Progression Kidney Failure Chronic Female medicine.symptom business Glomerular Filtration Rate Kidney disease |
| Zdroj: | Journal of Nephrology. 27:307-316 |
| ISSN: | 1724-6059 1121-8428 |
| DOI: | 10.1007/s40620-014-0057-0 |
| Popis: | 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. 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. 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. Segmental sclerosis and tubulointerstitial injury predict renal outcomes independent of clinical data in nephrotic IMN patients with decreased renal function. |
| Databáze: | OpenAIRE |
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