Abstract: TH-PO116

Clinicopathological Manifestation in Patients of Idiopathic Membranous Nephropathy Assigned to a Heterogeneous Group with Nephrotic Syndrome

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Kitajima, Shinji, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Toyama, Tadashi, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Hara, Akinori, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Iwata, Yasunori, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Sakai, Norihiko, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Shimizu, Miho, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Furuichi, Kengo, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  • Yokoyama, Hitoshi, Division of Nephrology, Kanazawa Medical University Hospital, Uchinada, Japan
  • Wada, Takashi, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
Background

The 20-year renal survival of Idiopathic membranous nephropathy (IMN) in Japanese adults with nephrotic syndrome was reported around 60%. Based on the electron microscopic findings, we reported that there are two distinct types, homogeneous type and heterogeneous type; synchronous electron dense deposits or various phases of dense deposits in basement membrane, respectively. (Kidney International in 2004). Our previous analysis revealed that the rate of renal death was around 20 times higher in heterogeneous group (heterogeneous group; 25.6%, homogeneous group; 1.3%). In this study, we evaluated the predisposing clinicopathological factors for IMN patients assigned to heterogeneous group with nephrotic syndrome (NS).

Methods

Forty patients of NS (24 males and 16 females; mean age 45.7 years) with heterogeneous type IMN were evaluated in this study who were collected in Kanazawa University Hospital and affiliated hospitals from 1965 to 2013. The patients were followed for more than three years, or until renal or patient death. Clinicopathological factors, which might affect renal death were evaluated.

Results

Renal death was observed 12 out of 40 patients (30%). We divided two groups; renal death group and renal survival group. The renal death group showed lower remission rate (CR or ICRI;renal death group; 16.7%, renal survive group; 60.7%, p=0.01), and higher sustained NS rate (renal death group; 50.0%, renal survive group; 10.7%, p=0.006). There was no difference in clinical background at onset between two groups. In renal death group, two patients achieved remission, but relapsed after the remission and became renal death. The median duration to renal death after kidney biopsy was 107 months, and patients of sustained NS had a tendency to shorter duration (NS group; 76.5months, non-NS group; 139.1months, p=0.10).

Conclusion

These findings suggest that electron microscopic findings demonstrating heterogeneous type and no-remission of nephrotic syndrome was susceptible to renal death in patients with nephrotic IMN.