Clinical covariates influencing clinical outcomes in primary membranous nephropathy

BMC Nephrology

Research

Lukas Westermann¹  Felix A. Rottmann¹  Rika Wobser¹  Thomas Welte²  Frederic Arnold²  Dawid L. Staudacher³  Martin J. Hug⁴ 

[1] Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Institute for Microbiology and Hygiene, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Interdisciplinary Medical Intensive Care (IMIT), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Pharmacy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;

关键词: Primary membranous nephropathy;    PLA2-R;    THSD7A;    Chronic kidney disease;    Immunosuppression;    Nephrotic syndrome;    Rituximab;   

DOI  :  10.1186/s12882-023-03288-x

 received in 2023-05-03, accepted in 2023-08-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPrimary membranous nephropathy (PMN) frequently causes nephrotic syndrome and declining kidney function. Disease progression is likely modulated by patient-specific and therapy-associated factors awaiting characterization. These cofactors may facilitate identification of risk groups and could result in more individualized therapy recommendations.MethodsIn this single-center retrospective observational study, we analyze the effect of patient-specific and therapy-associated covariates on proteinuria, hypoalbuminemia, and estimated glomerular filtration rate (eGFR) in 74 patients diagnosed with antibody positive PMN and nephrotic-range proteinuria (urine-protein-creatinine-ratio [UPCR] ≥ 3.5 g/g), treated at the University of Freiburg Medical Center between January 2000 – November 2022. The primary endpoint was defined as time to proteinuria / serum-albumin response (UPCR ≤ 0.5 g/g or serum-albumin ≥ 3.5 g/dl), the secondary endpoint as time to permanent eGFR decline (≥ 40% relative to baseline).ResultsThe primary endpoint was reached after 167 days. The secondary endpoint was reached after 2413 days. Multivariate time-to-event analyses showed significantly faster proteinuria / serum-albumin response for higher serum-albumin levels (HR 2.7 [95% CI: 1.5 – 4.8]) and cyclophosphamide treatment (HR 3.6 [95% CI: 1.3 – 10.3]). eGFR decline was significantly faster in subjects with old age at baseline (HR 1.04 [95% CI: 1 – 1.1]).ConclusionHigh serum-albumin levels, and treatment with cyclophosphamide are associated with faster proteinuria reduction and/or serum-albumin normalization. Old age constitutes a risk factor for eGFR decline in subjects with PMN.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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