Late Relapses of Membranous Nephropathy: A Case Series

Relapse of the nephrotic syndrome is co mmon among patients with primary membranous nephropathy (MN). Relapses of MN typically occur within a few years of achieving disease remission. There is limited description, to date, regarding patients with MN who have late relapse of MN, i.e., after >5 years of sustained disease remission. The objective of this case series was to report the clinical course of patients with MN who experience late relapse.

We analyzed the patient database of the Glomerular Kidney Disease Center at Columbia University to identify patients seen at our center who had relapse of biopsy specimen-proven MN at least 5 years after achieving sustained disease remission.

We identified 16 patients with late relapse of MN. The median time in sustained remission before relapse was 10.2 (range, 7-29.0) years. Ten patients (63%) were diagnosed with late relapse on the basis of laboratory monitoring alone, without clinical symptoms of the nephrotic syndrome. Fourteen patients (88%) received immunosuppression during their initial presentation and late relapse. Patients had favorable long-term renal outcomes over a median 21 (range, 12-56) year follow-up period, with 14 patients (88%) in remission at study conclusion and a median decline in eGFR per year of -0.63 (range, -6.3 to 17.5) ml/min per 1.73 m² per year.

This case series highlights a previously underappreciated, and likely rare, outcome of MN, namely, late relapse. Patients who experience late relapse, and who thus have a longer time in sustained remission, may have a more favorable long-term renal outcome.