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The natural history of the non-nephrotic membranous nephropathy patient

Michelle A Hladunewich1, Stephan Troyanov, Jennifer Calafati

  • 1University Health Network, University of Toronto, Toronto, Ontario, Canada.

Clinical Journal of the American Society of Nephrology : CJASN
|August 8, 2009
PubMed
Abstract

Insights

Patients with idiopathic membranous nephropathy (MGN) and subnephrotic proteinuria generally have a good prognosis. Close monitoring is advised, as predicting which patients will develop nephrotic range proteinuria and rapid progression is challenging.

Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • Idiopathic membranous nephropathy (MGN) is a common cause of nephrotic syndrome in adults.
  • Previous studies on MGN with subnephrotic proteinuria had limitations in sample size and follow-up duration.
  • The long-term outcomes for patients with MGN presenting with subnephrotic proteinuria require further investigation.

Purpose of the Study:

  • To evaluate the long-term outcomes of idiopathic membranous nephropathy (MGN) in patients presenting with subnephrotic range proteinuria.
  • To identify predictors of disease progression in this subgroup.
  • To inform clinical management strategies for MGN patients with subnephrotic proteinuria.

Main Methods:

  • Retrospective review of 395 idiopathic MGN cases from the Toronto Glomerulonephritis Registry with at least 12 months of follow-up.
  • Analysis of baseline and follow-up data including mean arterial pressure (MAP) and creatinine clearance (CrCl) using the Cockcroft-Gault equation.
  • Outcome variables assessed: rate of CrCl decline, 50% reduction in CrCl, and end-stage renal disease (ESRD).

Main Results:

  • 108 patients (27%) presented with subnephrotic proteinuria; 40% of these maintained subnephrotic levels with a slow CrCl decline (-0.93 ml/min/yr).
  • Patients who developed nephrotic range proteinuria exhibited a significantly faster progression rate (-3.52 ml/min/yr), with most developing it within the first year.
  • Higher baseline urine protein levels were associated with subsequent development of nephrotic syndrome.

Conclusions:

  • Idiopathic membranous nephropathy (MGN) patients with sustained subnephrotic proteinuria demonstrate an excellent long-term prognosis.
  • Conservative management and close monitoring are recommended due to the difficulty in predicting which patients will progress to nephrotic range proteinuria.
  • Early identification of risk factors may aid in tailoring treatment strategies for MGN.

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