Evaluation of Clinical Findings and Treatment Outcomes of Patients Diagnosed with Primary Membranous Nephropathy: A Single Center Experience

Abstract

Objective: Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in non-diabetic white adults. The primary aim of our study is to compare the demographic and clinical characteristics, treatment outcomes, and the occurrence of remission in patients with primary MN. Materials and Methods: Our study included 35 patients diagnosed with primary MN between January 2012 and January 2021. Based on risk classification, patients were distributed across low, moderate, high, and very high-risk groups. All patients were treated under Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results: The mean age of our patients was 55.9±10.8 years, and 71.4% were male. At diagnosis, almost all patients (97.1%) had nephrotic-level proteinuria. In the risk classification of the patients with MN, 13 (37.1%) patients were low risk, 11 (31.4%) patients were moderate risk, 8 (22.9%) patients were high risk, and 3 (8.6%) patients were in the very high-risk group. The overall remission rate at the end of the first year was 68.6%. The mean age of patients who achieved remission was 52.8±10.5, while the mean age of patients who did not achieve remission was 62.9±8.4 (p=0.008). The most commonly used immunosuppressive (IS) agent that combined with steroids was cyclophosphamide (65.7%), followed by calcineurin inhibitors (45.7%). Conclusion: High overall remission rates were observed at the end of the first year of MN treatment. IS treatment applied to MN patients may contribute to early remission.

Keywords

• Membranous nephropathy
• remission
• immunosuppressive treatment
• proteinuria

Primer Membranöz Nefropatili Hastaların Klinik Bulgularının ve Tedavi Sonuçlarının Değerlendirilmesi: Tek Merkez Deneyimi

Öz

Amaç: Membranöz nefropati (MN), diyabetik olmayan beyaz yetişkinlerde nefrotik sendromun en yaygın nedenidir. Çalışmamızın temel amacı, primer MN tanısı alan hastaların demografik ve klinik özelliklerini, tedavi sonuçlarını ve remisyon oluşumunu karşılaştırmaktır. Gereç ve Yöntemler: Çalışmamıza, Ocak 2012 ile Ocak 2021 arasında primer MN tanısı alan 35 hasta dahil edilmiştir. Risk sınıflandırmasına dayalı olarak hastalar düşük, orta, yüksek ve çok yüksek risk gruplarına dağıtılmıştır. Tüm hastalar, Böbrek Hastalığı: Sonuçların İyileştirilmesi (KDIGO) kılavuzları altında tedavi edilmiştir. Bulgular: Hastalarımızın ortalama yaşı 55.9±10.8 yıl olup, çoğunluğu (%71.4) erkekti. Tanı anında hastaların neredeyse tamamında (%97.1) nefrotik seviyede proteinüri mevcuttu. MN için yapılan risk sınıflandırmasında, 13 (%37.1) hasta düşük risk grubunda, 11 (%31.4) hasta orta risk grubunda, 8 (%22.9) hasta yüksek risk grubunda ve 3 (%8.6) hasta çok yüksek risk grubunda yer aldı. İlk yıl sonunda genel remisyon oranı %68.6 idi. Remisyon elde eden hastaların ortalama yaşı 52.8±10.5 iken, remisyon elde edemeyen hastaların ortalama yaşı 62.9±8.4 idi (p=0.008). Steroidlerle birlikte en yaygın kullanılan immünosupresif (IS) ajan, siklofosfamid (%65.7) olup, bunu kalsinörin inhibitörleri (%45.7) takip etti. Sonuç: Tek merkezli çalışmamızda, literatürle tutarlı olarak MN tedavisinin ilk yılı sonunda yüksek genel remisyon oranları gözlemlenmiştir. MN hastalarına uygulanan IS tedavi, erken remisyona katkıda bulunabilir.

Anahtar Kelimeler

• Membranöz nefropati
• remisyon
• immünosupresif tedavi
• proteinüri

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