Baralić Marko, Gajić Selena, Kostić Mihajlo, Stojadinović Milorad, Filić Kristina, Bjelić Danka, Karadžić-Ristanović Vidna, Mrđa Ivana, Gavrilović Jovana, Ćujić Danica, Sič Aleksandar, Janković Stefan, Putica Ivan, Stankovic Sanja, Vićentijević Dušan, Životić Maja, Radojević-Škodrić Sanja, Pavlović Jelena, Bontić Ana, Kezić Aleksandra
Clinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr Subotića Starijeg 8, 11000 Belgrade, Serbia.
Life (Basel). 2025 Aug 1;15(8):1221. doi: 10.3390/life15081221.
Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease (CKD) in up to 60% of patients, and 10 to 30% develop end-stage kidney disease (ESKD). This retrospective study examines the importance of specific factors, including baseline demographic and clinical data, kidney biopsy PH findings, and selected biochemical parameters, influencing MN outcomes after 10 years of follow-up. The cohort included 94 individuals in whom a diagnosis of MN was established by percutaneous biopsy of the left kidney's lower pole at the University Clinical Center of Serbia (UCCS) between 2008 and 2013. According to the outcomes, patients were divided into three groups: the recovery (Rec) group, with complete remission, including normal serum creatinine (Scr) and proteinuria (Prt), the group with development of chronic kidney disease (CKD), and the group with development of end-stage kidney disease (ESKD). Nephropathologists graded pathohistological (PH) results from I to III based on the observed PH findings. During the follow-up period, 33 patients were in the Rec group, CKD developed in 53 patients, and ESKD developed in 8 patients. Baseline creatinine clearance levels (Ccr), Scr, and uric acid (urate) were found to be significantly associated with the outcomes ( < 0.001). The lowest values of baseline Scr and urate were observed in the Rec group. The presence of acute kidney injury (AKI) or CKD at the time of kidney biopsy was associated with the more frequent development of ESKD ( = 0.02). Lower Ccr was associated with a higher likelihood of progressing to CKD (B = -0.021, = 0.014), whereas older age independently predicted progression to ESKD (B = 0.02, = 0.032). Based on this study, it was concluded that the most important biochemical and clinical factors that are associated with the outcomes of this disease are the values of Scr, Ccr, and urate and the existence of CKD at the time of kidney biopsy. Unlike most previous studies, the presence of HTN had no statistical significance in the outcome of the disease.
膜性肾病（MN）是成人肾病综合征（NS）最常见的病因，它可以是原发性（特发性）的，病因不明，也可以是继发于多种情况（狼疮、感染、恶性肿瘤、药物等）。高达60%的患者会进展为慢性肾脏病（CKD），10%至30%的患者会发展为终末期肾病（ESKD）。这项回顾性研究探讨了特定因素的重要性，包括基线人口统计学和临床数据、肾活检病理组织学（PH）结果以及选定的生化参数，这些因素对随访10年后MN的预后产生影响。该队列包括94名个体，2008年至2013年间在塞尔维亚大学临床中心（UCCS）通过经皮穿刺左肾下极活检确诊为MN。根据预后情况，患者被分为三组：完全缓解的恢复（Rec）组，包括血清肌酐（Scr）和蛋白尿（Prt）正常；慢性肾脏病（CKD）发展组；终末期肾病（ESKD）发展组。肾病理学家根据观察到的PH结果将病理组织学（PH）结果分为I至III级。在随访期间，33例患者属于Rec组，53例患者发展为CKD，8例患者发展为ESKD。发现基线肌酐清除率（Ccr）、Scr和尿酸（尿酸盐）水平与预后显著相关（<0.001）。Rec组观察到最低的基线Scr和尿酸盐值。肾活检时存在急性肾损伤（AKI）或CKD与ESKD更频繁的发生相关（=0.02）。较低的Ccr与进展为CKD的可能性较高相关（B=-0.021，=0.014），而年龄较大独立预测进展为ESKD（B=0.02，=0.0
