Kidney Week

Abstract: TH-PO1015

Treatment Patterns Among Adults with Membranous Nephropathy in the Cure Glomerulopathy Network (CureGN)

Session Information

• Glomerular Diseases: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Laurin, Louis-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Louis-Philippe Laurin,

• Bomback, Andrew S., Columbia University, New York, New York, United States

Andrew S. Bomback,

• Hladunewich, Michelle A., University of Toronto, Toronto, Ontario, Canada

Michelle A. Hladunewich,

• Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States

Jonathan P. Troost,

• Gillespie, Brenda W., University of Michigan, Ann Arbor, Michigan, United States

Brenda W. Gillespie,

• Kogon, Amy, Children's Hospital of Philadelphia, Wynnewood, Pennsylvania, United States

Amy Kogon,

• Gipson, Debbie S., University of Michigan Mott Children's Hospital, Ann Arbor, Michigan, United States

Debbie S. Gipson,

• Abbott, Kevin C., The National Institutes of Health, NIDDK, Bethesda, Maryland, United States

Kevin C. Abbott,

• O'Shaughnessy, Michelle M., Stanford University, Palo Alto, California, United States

Michelle M. O'Shaughnessy,

Group or Team Name

• CureGN Membranous Epi Treated vs. Not Treated Work Group

Background

Patients with membranous nephropathy (MN) and risk factors for progressive disease may benefit from immunosuppressive therapy (IST). Most guidelines and expert opinion recommend a 6-12 mo observation period before initiating IST. Current practice patterns regarding choice and timing of IST in MN remain largely unknown.

Methods

CureGN is an ongoing 70-center prospective cohort study of children and adults with biopsy-proven MCD, FSGS, MN, or IgAN/IgAV. Biopsies were performed between 2010 and 2017. Descriptive statistics were used to assess choice and timing of IST after kidney biopsy. Categorical data are presented as frequencies and % and compared using χ² tests; continuous data as median(IQR) and compared using the Kruskal-Wallis test.

Results

As of May 2018, 303 adult MN patients were enrolled in CureGN. Of those, 274 were considered unexposed to IST prior to biopsy, including 267 who received no prior IST and 7 who received steroids alone for a maximum of 6 wks before biopsy. Characteristics at biopsy: age 53 yrs (42-63), 36% Female, 71% White, UP:C 5.7 g/g (3.6-8.5), serum albumin 2.7 g/dl (2.1-3.6), eGFR 81 ml/min/1.73m² (57-103). 212/274 (77%) received IST (Table 1) for a median follow-up time of 31 mo (16-50), with 74% of IST treatments started in the first 6 mo after biopsy. 140/274 (51%) received RAAS blockers by 6 mo. Patients treated with IST (vs. untreated) within the first 6 mo after biopsy had higher UP:C (7.1 vs. 4.0 g/g; p<0.01), lower serum albumin (2.4 vs. 3.3 g/dl; p<0.01) and lower eGFR (77 vs. 89; p=0.03) at time of biopsy.

Conclusion

Seventy four percent of treated patients with biopsy proven MN were started on IST within the first 6 mo after kidney biopsy. IST choices were heterogeneous and many patients were treated with steroids alone. Reasons for poor alignment with KDIGO guidelines regarding timing and choice of IST in MN require further exploration.

Table 1. First IST among MN adult patients with no previous exposure to IST (N=274)

Funding

• NIDDK Support