Abstract: TH-PO115

Practice Patterns in Management and Outcomes of Primary Membranous Nephropathy: A Single Centre Experience

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Durcan, Martin E., Royal Preston Hospital , Preston, LANCASHIRE, United Kingdom
  • Elsayed, Mohamed, Royal Preston Hospital , Preston, LANCASHIRE, United Kingdom
  • Ponnusamy, Arvind, Royal Preston Hospital , Preston, LANCASHIRE, United Kingdom
Background

Membranous nephropathy is a common glomerular disease. In the last number of years there has been many clinical trials addressing its management. These trials have altered the treatment patterns of this condition by giving the physician more treatment options.The aim of this study was to review the practice patterns in management and outcomes of primary membranous nephropathy at a single U.K centre.

Methods

Clinical demographics, relevant laboratory values and modalities of treatments were collected on all patients with biopsy proven membranous nephropathy between 2004 and 2011. Patients were followed up until November 2016.

The following outcomes were of interest; complete remission (proteinuria less than 30mg/mmol and stable renal function), partial remission (at least 50% reduction in proteinuria from baseline and uPCR <300mg/mmol with stable renal function (<15% drop in eGFR), relapse (recurrence of proteinuria with ≥ 300mg/mmol) and a composite outcome of the following endpoints; doubling of baseline creatinine, start of renal replacement therapy or death.

Results

129 incident patients were followed up for a median of 5.56 years. Mean age of patients was 56.5 ±16.7 years of age. 66.6% of patients were male and remainder were female. Prevalence rate of hypertension was 60.6% while 17.4% had diabetes. Mean baseline eGFR was 62.9 ± 34.6 ml/min/1.73m2. Mean PCR and albumin at diagnosis was 769.83 mg/mmol and 27.9 ± 6.6 g/L, respectively. 56 (43.4%) received immunosuppressive therapy overall. 24 (19%) patients were treated with the Ponticelli regime.36 (28%) received a calcineurin inhibitor.12 (9.52%) received mycophenolate mofetial (MMF). Patient and renal survival at last follow up was 71.20%. 51% of study population obtained complete remission. 27% achieved partial remission. 40.17% achieved the composite outcome. Achieving remission (whether partial or complete) decreases hazards of developing composite outcome by 64%. P=0.0007. Please see figure 1. for survival outcomes related to each treatment modality.

Conclusion

Outcomes are comparable and better than what is reported in the literature. Treatment of patients with a calcineurin inhibitor seems to be superior to treatment with other modalities. Further analysis of this finding is needed.