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Abstract: FR-PO655

Outcomes of Idiopathic Membranous Nephropathy: A Single Centre Experience

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Bell, Christina, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Forbes, Anna K., Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Low, Benjamin, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Huque, Sumaya, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Gardner, Alexander Fd, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Makanjuola, David, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Sood, Bhrigu Raj, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
Background

The immunosuppressive approach to treat idiopathic membranous nephropathy is highly variable and outcomes are inconsistent in the published literature.

Methods

We conducted a retrospective review of outcomes in patients with high-risk idiopathic membranous nephropathy treated with immunosuppression at a teritary renal centre in London.

Results

We identified 44 patients, comprising 33 males and 11 females. Mean age was 58.6 years (standard deviation 13.4 years) and 82.6% were Caucasian. PLA2R antibody status was assessed in 59.1% (26/44 patients); of these 69.2% were positive. At treatment initiation median urine PCR was 962 mg/mmol (IQR 702 – 1277 mg/mmol), median albumin 21 g/L (IQR 16-28 g/L), median creatinine 136 μmol/L (IQR 98 – 180 μmol/L) and median eGFR 47 ml/min/1.73 m2 (IQR 26 -60 ml/min/1.73 m2).
First line therapy comprised of either IV cyclophosphamide in combination with oral prednisolone (C+P) (70.5%) or Tacrolimus monotherapy (Tac) (29.5%). We found a higher response rate in the Tac group at all time points (6,12 and 24 months) but these findings were not statistically significant. At 6 months, of those who received C+P 11.5% (3/26 patients) achieved complete remission (CR) and 46.2% (12/26 patients) achieved partial remission (PR). With Tac 45.5% (5/11 patients) achieved CR and 36.4% (4/11 patients) achieved PR.
Relapse rates within 24 months of treatment initiation were higher in patients who received Tac at 23.1% compared with 12.9% in those treated with C+P. However, this finding was not statistically significant.
7 patients progressed to ESKD and required renal replacement therapy, including 4 on C+P and 3 on Tac.

Conclusion

We have been unable to identify a difference in outcomes between C+P and Tac immunosuppression treatment regimens. Published literature suggest Rituximab is superior in patients who are PLA2R antibody positive and we are in the process of analysing this in our population.