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Non-glomerular Tip Lesion Focal Segmental Glomerulosclerosis as a Negative Predictor in Idiopathic Membranous

Hui Wang1,2, Cheng Wan1, Man Jiang1

  • 1Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.

Current Medical Science
|September 30, 2022
PubMed
Abstract

Insights

Focal segmental glomerulosclerosis (FSGS) variants impact idiopathic membranous nephropathy (IMN) outcomes. Non-glomerular tip lesion (GTL) FSGS is a negative predictor, worsening clinicopathological characteristics and reducing remission rates in IMN patients.

Area of Science:

  • Nephrology
  • Pathology
  • Clinical Medicine

Background:

  • Idiopathic membranous nephropathy (IMN) is a leading cause of nephrotic syndrome in adults.
  • Focal segmental glomerulosclerosis (FSGS) variants can coexist with IMN, potentially altering disease course.
  • Understanding the impact of FSGS variants on IMN is crucial for accurate prognostication and management.

Purpose of the Study:

  • To evaluate the influence of different FSGS variants on the clinicopathological features of IMN patients.
  • To assess the short-term outcomes, specifically remission rates, in IMN patients with varying FSGS patterns.
  • To identify predictors of poor response to treatment in IMN.

Main Methods:

  • Retrospective analysis of 146 IMN patients diagnosed between December 2016 and March 2019.
  • Classification of patients into pure IMN, IMN with glomerular tip lesion (GTL), and IMN with non-GTL FSGS groups.
  • Comparison of clinicopathological data, including hypertension, serum albumin, proteinuria, blood pressure, serum cholesterol, serum IgG, tubular injury, and chronic injury scores.

Main Results:

  • Patients with non-GTL FSGS and GTL showed higher rates of hypertension, lower serum albumin, and severe proteinuria compared to pure IMN.
  • The non-GTL FSGS group exhibited worse parameters including higher blood pressure, elevated cholesterol, and lower serum IgG.
  • One-year remission rates were 81.6% (IMN), 76% (IMN with GTL), and 58.8% (IMN with non-GTL FSGS), with non-GTL FSGS showing the lowest remission incidence.
  • Higher anti-PLA2R antibody levels and non-GTL FSGS lesions were independent predictors for non-remission.

Conclusions:

  • The presence of non-GTL FSGS lesions is a significant negative predictor in IMN.
  • Non-GTL FSGS variants are associated with adverse clinicopathological characteristics and poorer short-term outcomes in IMN.
  • Incorporating the assessment of FSGS variants, particularly non-GTL lesions, is essential for optimizing the management strategies for IMN patients.
Keywords:
focal segmental glomerulosclerosisglomerular tip lesionidiopathic membranous nephropathy

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