Clinical Features and Outcomes in Patients With Membranous Nephropathy and Crescent Formation
| Autor: | Zhen Qu, Gang Liu, Fang Wang, Xin Wang, Zhao Cui, Ming-Hui Zhao, Jia Wang, Fu-de Zhou, Jin-wei Wang, Yi-miao Zhang, Ping Zhu, Sai-nan Zhu |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology Kidney Glomerulus Renal function Observational Study urologic and male genital diseases Gastroenterology Glomerulonephritis Membranous chemistry.chemical_compound Membranous nephropathy Heavy proteinuria Internal medicine medicine Humans Risk factor Aged Retrospective Studies Creatinine Systemic lupus erythematosus business.industry urogenital system General Medicine Odds ratio Middle Aged medicine.disease female genital diseases and pregnancy complications Treatment Outcome chemistry Female business Nephritis Immunosuppressive Agents Glomerular Filtration Rate Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Cases of membranous nephropathy (MN) with crescent formation, in the absence of lupus, hepatitis B virus infection, anti-glomerular basement membrane (GBM) nephritis, or antineutrophil cytoplasmic antibody (ANCA), are on record. Clinical presentation and treatment outcomes in these patients are unclear. All patients with biopsy-proven MN diagnosed between years 2008 and 2014 and followed up were enrolled retrospectively. Patients with ANCA, anti-GBM antibodies, lupus, hepatitis B virus infection, or malignance were excluded. Clinical features and outcomes were compared between MN patients with and without crescent. Out of 401 consecutive patients with idiopathic MN, 28 (6.9%) showed crescent formation in 4.9% (2.2%–16.7%) of glomeruli. Mean age of these patients was 50.1 ± 11.1 years, and they presented with heavy proteinuria (6.5 ± 4.8 g/24 h) and hematuria; 21.4% of these patients had declined estimated glomerular filtration rate ( 0.05). Twelve (42.9%) patients received steroids plus immunosuppressive therapy similar to that in patients without crescent (41.3%). Fewer patients with crescents achieved remission (67.9% vs 86.7%, P = 0.029). Crescent formation was a risk factor for no response to the treatments (odds ratio [OR] = 3.1, P = 0.033). Higher percentage of crescents predicted more risk for no remission (OR = 1.2, P = 0.038). Patients with crescents presented more frequencies of abnormal serum creatinine during follow-up (10.7% vs 1.3%, P = 0.031). Crescent formation was also a risk factor for worse renal outcome (relative risk = 10.2, P = 0.046). MN patients with crescents showed unfavorable therapeutic response and tended to have worse renal outcomes. More aggressive treatments and renal protection might be considered to improve the outcomes. |
| Databáze: | OpenAIRE |
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