Abstract: TH-PO628
Comparison of Renal Outcomes Between Primary Membranous Nephropathy and Membranous Lupus Nephritis: A Prospective Multicenter Study
Session Information
- Glomerular Diseases: Clinical and Epidemiologic Studies
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Kim, Hyunglae, The Catholic University of Korea St Vincent's Hospital, Suwon, Gyeonggi-do, Korea (the Republic of)
- Kim, Yong Kyun, The Catholic University of Korea St Vincent's Hospital, Suwon, Gyeonggi-do, Korea (the Republic of)
Background
Primary membranous nephropathy (PMN) and membranous lupus nephritis (MLN) are autoimmune disorders characterized by immune complex deposit in the glomerular basement membrane. The optimal immunosuppressive regimen for these conditions remains undefined, and limited research exists on their renal outcomes.
Methods
This study included 108 patients with PMN and 43 patients with MLN (23 Class V only, 20 Class V + III or IV) diagnosed through renal biopsy at eight South Korean hospitals from September 2015 to April 2022. All patients received standard immunosuppressive therapy, including glucocorticoids with additional agents such as calcineurin inhibitors, mycophenolate mofetil, or cyclophosphamide. Renal outcome was assessed by comparing serum creatinine levels at baseline and one year, adjusted to baseline levels. The response rate was defined as CR (<0.5g/g reduction in proteinuria), PR (≥50% reduction in proteinuria), and TF (failure to achieve CR or PR). Median follow-up period for was 11 months in both PMN and MLN.
Results
PMN patients exhibited older age (57.5±12.9 vs 37.4±14.1, p<0.001), higher male proportion (86.1% vs 37.0%, p<0.001), higher BMI (26.0±4.6 vs 23.0±5.1, p=0.002), increased prevalence of hypertension (50% vs 16.3%, p<0.001), higher serum creatinine (0.9±0.4 vs 0.7±0.3, p=0.03), decreased albumin (2.6±0.7 vs 2.9±0.7, p=0.041), and increased urine protein creatinine ratio (6.1±3.6 vs 4.4±4.8, p=0.015) compared to MLN patients. After one year, in multivariated regression analysis, PMN patients showed that the increase rate of serum creatinine was higher than MLN patients (22.4% vs 11.7%, p=0.027), indicating worse renal function in the PMN group, while the reduction rate of proteinuria was similar in both groups (57.6% vs 61.7%, p=0.306). Response rates (CR+PR) and treatment failure rates (TF) did not significantly differ between the two groups (PMN: CR+PR=77.8%, TF=22.2%; MLN: CR+PR=76.7%, TF=23.3%; p=0.891).
Conclusion
This study showed the comparable response rate between PMN and MLN patients after treatment with immunosuppression. However, PMN patients had more deteriorated renal function compared to MLN patients during the median follow-up period of 11 months. Further evaluation with longer follow-up is necessary to gain comprehensive insights into renal outcomes in these patient groups.