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Abstract: FR-PO858

Clinical Predictors of Acute Tubular Necrosis in Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Leisring, Joshua, Ohio State University Medical Center, Columbus, Ohio, United States
  • Kothari, Shaili S., Ohio State University Medical Center, Columbus, Ohio, United States
  • Bhatt, Udayan Y., Ohio State University Medical Center, Columbus, Ohio, United States
  • Satoskar, Anjali A., Ohio State University Medical Center, Columbus, Ohio, United States
  • Rovin, Brad H., Ohio State University Medical Center, Columbus, Ohio, United States
  • Parikh, Samir V., Ohio State University Medical Center, Columbus, Ohio, United States
Background

Acute tubular necrosis (ATN) is a common and important complication associated with membranous nephropathy (MN). Proteinuria magnitude is suggested as a cause for ATN in MN however clinical contributors to ATN in MN have not been previously evaluated. We queried the OSUWMC kidney biopsy repository to investigate predictors associated with ATN, and specifically explored the relationship between proteinuria magnitude and ATN in MN.

Methods

Ninety-five patients who underwent kidney biopsy from 2004 to 2017 were found to have MN. Pathology reports were reviewed for histologic findings including ATN. Patient demographics and clinical metrics collected at the time of biopsy were analyzed to determine their ability to predict ATN using univariate and multivariate testing. Metrics considered included age, gender, race, serum albumin, cholesterol, and proteinuria magnitude at diagnosis.

Results

A histologic diagnosis of ATN was identified in forty-three patients (45%) with MN. Serum creatinine at time of biopsy was higher in patients with ATN (1.39 mg/dL, IQR 1.06-2.3) compared to those without ATN (1.18 mg/dL, IQR 0.89-1.63), p=0.04. Proteinuria magnitude was the only clinical variable associated with ATN on multivariate testing (p=0.05).

Proteinuria magnitude was then stratified into quartiles and ATN frequency was compared (Table 1). Overall, patients with > 4g/d proteinuria had a significantly higher rate of ATN on biopsy compared to those with 0-4g/d proteinuria (52.1% vs 22.3% respectively; OR: 3.7, 95% CI 1.23-11.07, p=0.03). The ATN rate did not differ at higher degrees of proteinuria above 4 g/d.

Conclusion

ATN commonly accompanies MN and is associated with a higher degree of renal impairment. Patients with MN and > 4 g/d proteinuria are at higher risk for ATN which may have both therapeutic and prognostic implications. Interestingly higher degrees of proteinuria did not further increase ATN rate suggesting additional factors may be involved and requires further study.

ATN Frequency According to Proteinuria Level
Magnitude of ProteinuriaFrequency of ATN
0-4 g/d22.73%
4-6 g/d50.00%
6-11 g/d52.17%
> 11 g/d53.57%