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Kidney Week

Abstract: FR-PO866

Waiting for Spontaneous Remission in Primary Membranous Nephropathy: Is It Safe?

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Vink- van Setten, Coralien, Radboud University Medical Center, Nijmegen, Netherlands
  • van de Logt, Anne-Els, Radboud University Medical Center, Nijmegen, Netherlands
  • Wetzels, Jack F., Radboud University Medical Center, Nijmegen, Netherlands
Background

We advocate a restrictive treatment strategy in patients with primary membranous nephropathy (pMN): immunosuppressive therapy(IS) is started late, while awaiting spontaneous remission. Many patients thus have persistent nephrotic syndrome for >12 months. Since proteinuria is associated with podocyte loss, delaying treatment might increase the risk of podocte depletion and secondary FSGS. We evaluated the outcome in patients with persistent proteinuria not receiving IS within 12 months after onset of disease.

Methods

We included patients with pMN, normal eGFR and nephrotic range proteinuria (urinary protein/creatinine ratio(uPCR) >3.0 g/10mmol) at presentation and followed for >2 years. We assume that in patients with podocyte loss and secondary FSGS, a complete remission(CR) will not occur. Therefore we selected patients with early and late spontaneous partial remission(SRem) and compared CR rate as outcome parameter. Partial remission(PR) was defined as uPCR <3.0g/10mmol and >50% decrease from baseline and stable kidney function. CR was defined als uPCR <0.2g/10mmol with stable kidney function.

Results

We included 254 patients. 12 months(m) after first presentation, 64(25%) patients were treated with IS and 47(19%) patients were in SRem. 94(37%) achieved SRem after 12 months, 33(13%) were eventually treated with IS, and 16(6%) had no IS nor remission. Baseline characteristics of the patients with SRem <12 months vs. SRem >12 months were comparable, except for number of aPLA2r positive patients. CR rate was comparable (47 vs. 40%). In patients who started with IS >12 months after diagnosis, PR was achieved in 27(82%) and CR in 17(51%).

Conclusion

Waiting for SRem in pMN is safe. Most patients with persisting proteinuria for more than 12 months develop a remission, even if immunosuppressive therapy is needed.

Comparison of early vs. late spontaneous remission in pMN
Group (N)Spontaneous remission <12m (N=47)Spontaneous remission >12m (N=94)
Females N(%)16 (34%)34 (36%)
Age at onset*52 [38-61]51 [39-58]
Baseline serum creatinine (mmol/L)*
Baseline serum albumin (g/L)*
Baseline uPCR (g/10mmol)*
Baseline aPLA2r positive IFT N(%)∫
82 [69-91]
24 [20-28]
6.1 [4.7-7.7]
18/34 (53%)
81.5 [70-90.25]
24 [20-27.5]
6.7 [4.5-9.4]
38/49 (78%)
Complete remission N(%)
Time to complete remission (months) *
22 (47%)
30.5 [22.75-53]
38 (40%)
40 [25-72]
Relapse N(%)11 (23%)23 (24%)
Follow-up duration (months)*76 [46-118]75.5 [43.5-138.25]
Increase in serum creatinine at the end of follow-up*6.9% [-5.4-16.4]12.3% [-2.1-25.5]

*Median[IQR] ∫p=0.02