OUTCOME OF PRIMARY MEMBRANOUS NEPHROPATHY IN DIABETIC AND NON-DIABETIC PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY.

Introduction:

The number of renal biopsies in diabetic patients has risen significantly, challenging the long-held assumption that diabetic nephropathy was the primary driver of increasing proteinuria and declining renal function. The occurrence of membranous nephropathy in diabetic patients can complicate their further course. Hence, we investigated the clinical profile and treatment outcomes in patients diagnosed with membranous nephropathy, both with and without diabetes at our centre.

Methods:

Patients who underwent renal biopsy between January 2023 and June 2024 were screened. The clinicopathological profile of diabetic patients with primary membranous nephropathy (PMN) was compared with those without diabetes. Serum creatinine, albumin, 24-hour urine protein, and anti-PLA2R levels were monitored and followed up at 1, 3, 6, and 12 months. All patients were positive for serum Anti-PLAR level and received immunosuppression

Results:

Out of 255 patients who underwent renal biopsy, 14 (5.4%) had diabetes, and 10 (3.9%) of these diabetic patients had nephrotic syndrome presentation. Seven (2.7%) of these patients with nephrotic syndrome had membranous nephropathy. Five patients (1.9%) had coexisting DKD with stage 3, and two patients had non-proliferative diabetic retinopathy. Seventeen patients among 255 (6.6%) had PMN without diabetes. The baseline parameters used to compare diabetic versus non-diabetic patients with PMN were age (58.43 ± 11.16 vs. 38.24 ± 14.13 years, p=0.003); Serum creatinine (1.77 ± 1.53 vs. 1.03 ± 0.43; p=0.040); eGFR (63.57 ± 24.93 vs. 99.12 ± 25.71; p=0.004); Serum albumin (2.24 ± 0.72 vs. 1.93 ± 0.48; p=0.383) and 24-hour urine protein (7.74 ± 2.6 vs. 6.91 ± 3.96; p=0.455). In renal biopsy IFTA was 17.86 ± 8.59 vs.9.88 ± 8.12; p=0.019, respectively. Diabetic patients had high S.cr and low GFR compared to PMN on follow-up at 6 months (2.25± 1.7 vs 0.97±0.25; p=0.01). Other parameters compared between diabetic vs nondiabetic with PMN were serum albumin (2.8±1.2 vs3.47±0.65; p=0.289), 24-hour urine protein (6.7880±5.9324 vs 3.1831±1.581;p=0.052) and serum PLA2R negativity  (80% VS 66.7%;p=1). Complications were more frequent in the diabetic group (42.9% vs 11.8%). Two patients had tuberculosis and one had uncontrolled hyperglycemia. One patient became dialysis dependent. In the non-diabetic, one had an osteoporotic fracture and another patient had hyperpigmentation.

Conclusions:

Compared to PMN in non-diabetic, diabetic patients were more elderly, had lower eGFR, and the amount of IFTA was higher. Immunological remission and proteinuria were not different between the two groups during the follow-up in our study.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.