Abstract: TH-PO638
Membranous Nephropathy: A Retrospective Observational Study in a Single Renal Unit
Session Information
- Glomerular Diseases: Epidemiology and Case Reports
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
- Tan, Mei Ying, Royal Derby Hospital, Derby, United Kingdom
- Mohammed, Elshaeima, Royal Derby Hospital, Derby, United Kingdom
- Fluck, Richard James, Royal Derby Hospital, Derby, United Kingdom
- Ng, Khai Ping, Royal Derby Hospital, Derby, United Kingdom
Background
Membranous Nephropathy (MN) is a common cause of nephrotic syndrome in adults. The diagnosis and treatment paradigms for MN have evolved with the identification of PLA2R autoantibodies and evidence for the use of Rituximab. We aim to retrospectively examine the treatments and outcomes of all adults diagnosed with MN in a single renal centre, March 2013 to March 2023.
Methods
Patients' demographics, clinical presentation, treatments, full remission (FR), partial remission (PR), relapse, renal outcome and complications were collected via electronic health records.
Results
In total, 75 patients were identified with 13 diagnosed as secondary MN. Of the 58 patients with primary MN, their mean age was 57 (SD=14) years with 72% male and 35% positive serum anti-PLA2R. At diagnosis, their mean eGFR was 68 (SD=27) ml/min, uPCR 781 (SD=557) mg/mmol, serum albumin 20 (SD 6) g/L. 98% received RAAS inhibitor. Ten patients (17%) achieved FR or PR without further need of immunosuppressive therapy (IS). Of the 48 patients, the median time from diagnosis to start of IS was 2 (IQR 4) months. The majority (63%) received oral cyclophosphamide and prednisolone (CYP) as first line IS, whilst 19%, 15% and 4% received calcineurin inhibitor (CNI), prednisolone only and Rituximab, respectively. After first IS, 26% and 24% achieved FR and PR. 23 patients (47%) required second course of IS whilst 11 and 5 patients required third and fourth courses of IS, respectively. Relapses occurred in 29% of the patients. Overall, the mean eGFR at 6 months, 12 months, 2 years and 5 years was 64, 61, 62, 56 ml/min, two progressed to kidney failure and five died. The FR and PR rates were 41%, 37% following CYP, 47%, 11% following CNI and 27%, 64% following Rituximab. Pancytopenia (n=1), deranged liver function test (n=2), recurrent or opportunistic infections (n=3) and malignancies (n=4) were reported amongst those who received CYP. No significant complications were reported with Rituximab since its first use in October 2020.
Conclusion
In this cohort of MN, their overall long-term renal outcome was favourable. Although the FR rate was < 50%, progression to kidney failure was rare. Relapses remain a challenge. IS is complicated by infection and neoplasia. Biologics and diagnostics may refine therapy options in the future.