Lee Taewoo, Chung Yunro, Poulton Caroline J, Derebail Vimal K, Hogan Susan L, Reich Heather N, Falk Ronald J, Nachman Patrick H
UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Medicine, Division of Nephrology, St. Louis University, St. Louis, Missouri, USA.
Kidney Int Rep. 2020 Mar 4;5(5):706-717. doi: 10.1016/j.ekir.2020.02.1030. eCollection 2020 May.
In primary membranous nephropathy (MN), partial remission (PR) (≥50% reduction of proteinuria to <3.5 g/d) is associated with a greater risk of relapse and end-stage kidney disease (ESKD) compared with complete remission (CR). We aimed to determine factors associated with relapse or renal failure in patients who attain the standard definition of PR.
We captured PR, CR, relapse, and the composite of doubling of serum creatinine or ESKD in a cohort of 267 patients with MN, nephrotic syndrome, and >12 months of follow-up. Characteristics at the time of PR associated with the composite outcome or relapse were evaluated using a time-to-event analysis.
A total of 192 patients attained PR and 86 attained CR. Serum albumin at PR (hazard ratio [HR]: 1.58 per 0.5 g/dl decrease from 4.0 g/dl; 95% confidence interval [CI]: 1.03-2.43) and duration of nephrotic proteinuria (HR: 1.01 per month increase; 95% CI: 1.00-1.03) were independent risk factors for the composite endpoint. Serum albumin at PR was associated with an increased risk of relapse (HR: 1.58 per 0.5 g/dl decrease below 4.0 g/dl; 95% CI: 1.24-2.01). A cutoff for serum albumin ≤3.5 g/dl at PR performed best in predicting relapse and composite outcome.
Patients with serum albumin >3.5 g/dl at PR have decreased risk of composite outcome or relapse compared with PR with low albumin. A definition of PR that includes normalization of serum albumin may be a more robust surrogate endpoint in MN than the traditional definition of PR.
在原发性膜性肾病（MN）中，与完全缓解（CR）相比，部分缓解（PR）（蛋白尿减少≥50%至<3.5g/d）与更高的复发风险和终末期肾病（ESKD）风险相关。我们旨在确定达到PR标准定义的患者中与复发或肾衰竭相关的因素。
我们在一个包含267例MN、肾病综合征且随访时间>12个月的队列中记录了PR、CR、复发以及血清肌酐翻倍或ESKD的复合情况。使用事件发生时间分析评估PR时与复合结局或复发相关的特征。
共有192例患者达到PR，86例达到CR。PR时的血清白蛋白（风险比[HR]：每从4.0g/dl降低0.5g/dl为1.58；95%置信区间[CI]：1.03 - 2.43）和肾病性蛋白尿持续时间（HR：每月增加1.01；95%CI：1.00 - 1.03）是复合终点的独立危险因素。PR时的血清白蛋白与复发风险增加相关（HR：低于4.0g/dl每降低0.5g/dl为1.58；95%CI：1.24 - 2.01）。PR时血清白蛋白≤3.5g/dl的临界值在预测复发和复合结局方面表现最佳。
与低白蛋白的PR相比，PR时血清白蛋白>3.5g/dl的患者复合结局或复发风险降低。包含血清白蛋白正常化的PR定义可能比传统的PR定义更能作为MN中可靠的替代终点。
