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Risk factors for relapse and aggravation in membranous nephropathy after COVID-19 infection
Yue Shu1, Jing Huang1, Yi-Miao Zhang1
1Renal Division, Institute of Nephrology, Key Laboratory of Renal Disease, Key Laboratory of CKD Prevention and Treatment, Peking University First Hospital, Peking University, Ministry of Health of China, Ministry of Education of China, Beijing, China.
Background:
Relapse of membranous nephropathy (MN) and other glomerular diseases has been observed after COVID-19 infection. The risk factors contributing to disease progression in MN patients after contracting COVID-19 remain unclear.
Methods:
This retrospective study included 656 consecutive patients with biopsy-proven primary MN who received treatment and were regularly followed up for over six months. Logistic regression analyses were conducted to identify risk factors for disease progression.
Results:
Among the cohort, 555 patients (84.6%) contracted COVID-19 from November 11th, 2022, to February 22nd, 2023. Of them, 112 patients (20.2%) experienced a > 50% increase in proteinuria, including 30 patients (5.4%) who experienced nephrotic syndrome relapse. Sixteen patients (2.9%) showed immune aggravation with elevated anti-PLA2R antibody levels, and five patients (0.9%) had immune relapse characterized by antibody reoccurrence. Kidney dysfunction, defined as an eGFR reduction > 30% from baseline, occurred in 10 patients (1.8%), with two patients (0.4%) progressing to ESKD. Four patients (0.7%) died of respiratory failure. Overall, 132 patients (24.0%) experienced disease progression after COVID-19 infection. Multivariate logistic regression identified longer fever duration (OR 1.118, 95% CI 1.029-1.356, P = 0.018), withdrawal of immunosuppressants and/or steroids (OR 2.571, 95% CI 1.377-4.799, P = 0.003) and extended drug cessation (OR 1.113, 95% CI 1.045-1.186, P = 0.001) as independent risk factors for MN progression.
Conclusions:
These findings suggest prompt antiviral treatment and minimizing the duration of immunosuppressant withdrawal to optimize kidney outcomes in MN patients with COVID-19.
Insights
COVID-19 infection can cause relapse in membranous nephropathy (MN) patients. Longer fever, stopping immunosuppressants, and extended drug cessation increase the risk of MN progression after COVID-19.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Membranous nephropathy (MN) relapse is observed post-COVID-19.
- Risk factors for MN progression after COVID-19 are not well understood.
Purpose of the Study:
- Identify risk factors for disease progression in membranous nephropathy patients following COVID-19 infection.
Main Methods:
- Retrospective study of 656 patients with biopsy-proven primary MN.
- Logistic regression analysis to determine risk factors for disease progression.
Main Results:
- 24.0% of patients experienced disease progression after COVID-19.
- Independent risk factors for MN progression include longer fever duration, immunosuppressant withdrawal, and extended drug cessation.
- Specific outcomes included increased proteinuria, nephrotic syndrome relapse, immune aggravation, kidney dysfunction, and progression to end-stage kidney disease (ESKD).
Conclusions:
- Prompt antiviral treatment is recommended for MN patients with COVID-19.
- Minimizing immunosuppressant withdrawal duration is crucial for optimizing kidney outcomes.
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