Gupta Sanjana, Connolly John, Pepper Ruth J, Walsh Stephen B, Yaqoob Magdi M, Kleta Robert, Ashman Neil
UCL Centre for Nephrology, 1st Floor, Room 1.7007, Rowland Hill Street, London, NW3 2PF, UK.
Renal Unit, Barts Health NHS Trust, Whitechapel, London, E1 1BB, UK.
BMC Nephrol. 2017 Jun 21;18(1):201. doi: 10.1186/s12882-017-0615-5.
Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults. MN is a clinically heterogeneous disease and it is difficult to accurately predict outcomes (including end stage renal failure) at presentation and whom to treat with potentially toxic therapies. We aimed to identify factors predicting outcome in MN in our cohort from two large tertiary London units by undertaking a retrospective data analysis of 148 biopsy-proven MN patients from North East and Central London between 1995 and 2015.
Review of clinical and biochemistry databases.
Surprisingly, patients that reached end stage renal failure (ESRF) had a less severe nephrosis compared to those that did not develop ESRF; serum albumin 33 g/L (3.3 g/dL) versus 24 g/L (2.4 g/dL), p = 0.002 and urinary protein creatinine ratio (uPCR) 550 mg/mmol (5500 mg/g) versus 902 mg/mmol (9020 mg/g), p = 0.0124. The correlation with ESRF was strongest with the presenting creatinine; 215 μmol/L (2.43 mg/dL) compared to 81 μmol/L (0.92 mg/dL), p < 0.0001. Patients presenting with creatinine of >120 μmol/L (1.36 mg/dL; corresponding to an eGFR of ≤60 ml/min in non-Black males) had an increased rate of ESRF and a faster decline. Other traditional risk factors for progression were not significantly associated with ESRF. Black patients presented with higher serum creatinine but no statistically significant difference in the estimated glomerular filtration rate, a higher rate of progression to ESRF and had a poorer response to treatment.
This ethnically diverse cohort does not demonstrate the traditional risk profile associated with development of ESRF. Thus, careful consideration of therapeutic options is crucial, as current risk modelling cannot accurately predict the risk of ESRF. Further studies are required to elucidate the role of antibodies and risk genes.
膜性肾病（MN）是成人肾病综合征的主要病因。MN是一种临床异质性疾病，在疾病初发时很难准确预测其预后（包括终末期肾衰竭），也难以确定哪些患者适合接受具有潜在毒性的治疗。我们通过对1995年至2015年间来自伦敦东北部和中部的148例经活检证实为MN的患者进行回顾性数据分析，旨在确定我们队列中MN患者预后的预测因素。
回顾临床和生化数据库。
令人惊讶的是，与未发展为终末期肾衰竭（ESRF）的患者相比，发展为ESRF的患者肾病程度较轻；血清白蛋白水平分别为33 g/L（3.3 g/dL）和24 g/L（2.4 g/dL），p = 0.002；尿蛋白肌酐比值（uPCR）分别为550 mg/mmol（5500 mg/g）和902 mg/mmol（9020 mg/g），p = 0.0124。与ESRF相关性最强的是初发时的肌酐水平；分别为215 μmol/L（2.43 mg/dL）和81 μmol/L（0.92 mg/dL），p < 0.0001。初发时肌酐水平>120 μmol/L（1.36 mg/dL；在非黑人男性中对应估算肾小球滤过率≤60 ml/min）的患者ESRF发生率更高且病情进展更快。其他传统的疾病进展风险因素与ESRF无显著相关性。黑人患者初发时血清肌酐水平较高，但估算肾小球滤过率无统计学显著差异，进展为ESRF的发生率更高且对治疗反应较差。
这个种族多样的数据队列并未显示出与ESRF发生相关的传统风险特征。因此，由于当前的风险模型无法准确预测ESRF风险，仔细考虑治疗方案至关重要。需要进一步研究以阐明抗体和风险基因的作用。
