Introduction:
Primary Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults, characterized by the deposition of immune complexes on the subepithelial side of the glomerular basement membrane. Clinically it is presented with peripheral edema, hypertension, frothy urine, and manifestations of thromboembolic phenomena.
Methods:
A retrospective cohort study including patients with biopsy-proven primary membranous nephropathy was conducted from January 2016 to December 2023. All patients had undergone tissue PLA2R staining and serum PLA2R in native kidney biopsies with features of MN on light microscopy. Patients with secondary causes of membranous nephropathy were excluded. Clinical and laboratory data were collected at baseline and during follow-up. Patients were categorized into four groups according to risk stratification and treatment was given according to KDIGO guidelines . Group 1 received calcineurin inhibitors, group 2 received modified ponticelli regimen, group 3 received rituximab and group 4 received only supportive care.The primary outcomes were number of patients who underwent complete remission (CR), partial remission (PR), and no remission at 6 months and 12 months.
Results:
The mean age of the patients was 45.6 ± 14.5 years, with a M : F ratio of 1:1 .At baseline, all patients presented with nephrotic range proteinuria (24hr urine protein mean 7277.86 + 3675.1 mg/day /UPCR mean 9.2 + 3.12 mg/g ), 26 (17.33 % ) had impaired renal function (S Cr mean 2.1 ± 1.2mg/dl ) and 2% of patients had thromboembolic events. At 6 months 79 (52%), 54(36%) , 17 (11%) patients were in CR, PR and NR respectively. At 12 months 87 (58%) , 50 (33%) ,13 (8%) patients were in CR, PR and NR respectively. Among 53 Patients treated with modified ponticelli regimen 62.2 % attained CR, 28.7 % attained PR, 8.2 % were non responders. Among 42 patients treated with Rituximab 57.1% patients achieved CR, 29.7 % achieved PR, 15.1 % were non responders. Among 30 patients treated with CNI 53.3 % achieved CR, 35.6 % achieved PR and 11.7 % were non responders. Among 25 patients in the conservative group 28 % achieved CR, 32 % achieved PR and 40 % were non responders. The non responders in group 1 and group 3 were treated with Rituximab and were able to achieve complete remission after period of 6 months.The complete remissions rates in Rituximab vs modified ponticelli vs CNI group was comparable ( 58.4 % vs 62.2% vs 52.7% ) and was statistically not significant ( p = 0.93 )
Conclusions:
Our study provides insights into the clinical characteristics and outcomes of MN. Factors associated with complete remission were younger age, female sex, early presentation and Sub nephrotic range proteinuria. Conversely, factors associated with non responders were older age, male sex, massive proteinuria , non compliance to medications , and impaired renal failure.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.