Clinical implications of pathological features of primary membranous nephropathy

• Published in: BMC nephrology 2018-08, Vol.19 (1), p.215-215, Article 215
• Main Authors: Zhang, Xiao-Dan, Cui, Zhao, Zhang, Mu-Fan, Wang, Jia, Zhang, Yi-Miao, Qu, Zhen, Wang, Xin, Huang, Jing, Wang, Fang, Meng, Li-Qiang, Cheng, Xu-Yang, Wang, Su-Xia, Liu, Gang, Zhao, Ming-Hui
• Format: Article
• Language: English
• Subjects: Aging; Analysis; Antibodies; Biopsy; Clinical medicine; Creatinine; Epidermal growth factor receptors; Excretion; Immunofluorescence; Immunoglobulins; Kidney diseases; Kidneys; Medical prognosis; Medical records; Membranous nephropathy; Microscopy; Multivariate analysis; Nephrology; Nephropathy; Pathology; Patient outcomes; Patients; Prognosis; Proteinuria; Remission; Risk factors; Sclerosis; Studies; Treatment outcome; Tubulointerstitial injury
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-018-1011-5

The clinical outcome varies considerably in primary membranous nephropathy (pMN). Risk factors for kidney prognosis include ageing, male gender, persistent heavy proteinuria, decreased eGFR at presentation, persistent elevation of anti-PLA2R antibodies, no remission, and so on. It was controversial whether the histopathological features of pMN could predict treatment response and kidney outcome. A retrospective study was conducted in 371 patients with biopsy-proven pMN. Pathological parameters included immunofluorescence staining, membranous Churg's stages, sclerosis, crescent, focal segmental sclerosis lesion, chronic and acute tubulointerstitial injury. The fluorescence intensity was determined: 0, negative; 1, weak; 2, moderate; 3, strong; 4, glaring. Chronic tubulointerstitial injury was graded by the involved area: 0, 0-5%; 1, 6-25%; 2, 26-50%; 3, > 50%. We found that patients with higher intensity of C3 staining, advanced membranous stage, and more severe chronic tubulointerstitial injury presented with higher positivity rate of anti-PLA2R antibodies, higher levels of urinary protein excretion and serum creatinine, and lower level of serum albumin. Univariate Cox regression analysis showed that severe (grade = 3) chronic tubulointerstitial injury was a risk factor to the kidney outcome of ESKD (HR = 61.02, 95%CI, 7.75-480.57, P  0.05). We found the prognostic role of chronic tubulointerstitial injury to the kidney outcome of pMN. This study highlighted the value of kidney biopsy under the widespread usage of anti-PLA2R antibodies for diagnosis and prognosis.