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[Membranous nephropathy in a Russian population]
V A Dobronravov1, D A Mayer1, O V Berezhnaya1
1I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia.
Aim:
To analyze the clinical and morphological manifestations of membranous nephropathy (MN) and to evaluate the efficiency of its therapy.
Material And Methods:
MN cases in 2009 to 2016 were retrospectively detected with a subsequent analysis of patients with primary MN (PMN). The titer of IgG-autoantibodies to phospholipase A2 receptor (anti-PLA2R Ab) was determined by an indirect immunofluorescence assay. Treatment outcomes, such as the time course of changes in proteinuria, nephrotic syndrome (NS), and the development of complete and partial remissions (CR and PR), were assessed.
Results:
MN was detected in 201 cases; the secondary etiology of the disease was established in 24.9%. The prevalence of MN among morphologically confirmed glomerulopathies was 14%; that of PMN was 10.4%. The median period to diagnosis PMN was 8 (5; 19) months. 150 patients with PMN (66.7% were men; age was 50±15 years) were distributed according to the following morphological stages: Stages I (23.9%), II (48.5%), III (26.1%), and IV (1.5%). Elevated anti-PLA2R Ab levels were found in 51.6% of cases; NS in the presence of proteinuria was detected in 85.6% of patients. An estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 was seen in 25% of cases. Treatment outcomes were evaluated in 80 cases; the median follow-up period was 19 (8; 40) months. 68% of cases had CR (32%) or PR (36%) with a median follow-up of 26 (13; 44) months. Spontaneous CRs or PRs were observed in 7.5% of the patients. Multivariate analysis showed that the probability of CR or PR increased 3.2-fold in the use of cyclophosphamide and/or cyclosporine and decreased as eGFR dropped.
Conclusion:
In Russia, PMN is a common type of glomerulopathy, the specific features of which should include the low rates of spontaneous remissions and detection of anti-PLA2R Abs. For renal protection, the majority of patients with PMN require timely diagnosis and treatment; individualization of the choice of treatment and its enhanced efficiency call for further investigations.
Insights
Primary membranous nephropathy (PMN) is common in Russia, often requiring treatment due to low spontaneous remission rates. Early diagnosis and tailored therapies, potentially including cyclophosphamide or cyclosporine, improve outcomes for PMN patients.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Membranous nephropathy (MN) is a significant cause of glomerulopathy.
- Primary membranous nephropathy (PMN) constitutes a substantial portion of MN cases.
- Understanding PMN's clinical and morphological features is crucial for effective management.
Purpose of the Study:
- To analyze the clinical and morphological characteristics of membranous nephropathy (MN).
- To evaluate the therapeutic efficacy in patients with primary membranous nephropathy (PMN).
- To identify factors influencing treatment outcomes in PMN.
Main Methods:
- Retrospective analysis of 201 MN cases diagnosed between 2009 and 2016.
- Assessment of IgG-autoantibodies to phospholipase A2 receptor (anti-PLA2R Ab) titers.
- Evaluation of treatment outcomes including proteinuria, nephrotic syndrome (NS), and remission rates (CR/PR).
Main Results:
- PMN accounted for 10.4% of glomerulopathies; 24.9% of MN cases had secondary causes.
- Elevated anti-PLA2R Ab levels were detected in 51.6% of patients.
- Complete or partial remission (CR/PR) was achieved in 68% of treated patients, with improved rates using cyclophosphamide/cyclosporine.
Conclusions:
- PMN is a prevalent glomerulopathy in Russia with low spontaneous remission rates.
- Detection of anti-PLA2R antibodies is a key feature in Russian PMN cases.
- Timely diagnosis and individualized treatment are essential for renal protection in PMN.
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