Journal Article

Low glomerular density is a risk factor for progression in idiopathic membranous nephropathy

Nobuo Tsuboi, Tetsuya Kawamura, Yoichi Miyazaki, Yasunori Utsunomiya and Tatsuo Hosoya

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 11, pages 3555-3560
Published in print November 2011 | ISSN: 0931-0509
Published online July 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr399
Low glomerular density is a risk factor for progression in idiopathic membranous nephropathy

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Background. The adverse histological features predicting a progressive loss of renal function in idiopathic membranous nephropathy (IMN), before the establishment of impaired renal function with advanced glomerulosclerosis and/or interstitial fibrosis, are still poorly understood. The present study examined the relationship between the glomerular density (GD; non-sclerotic glomerular number/renal cortical area of biopsy) and the renal prognosis in IMN patients, especially in those without any apparent renal dysfunction at the time of diagnosis.

Methods. The predictive value of the factors at biopsy, including the GD, on the renal outcome was retrospectively analyzed in the 65 IMN patients with an estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73m2 (mean, 80 mL/min/1.73m2) at biopsy.

Results. The individual values for GD ranged from 1.6 to 6.5/mm2 with 4-fold variation. A lower GD was associated with progression based on a ≥50% reduction in eGFR or reaching to end-stage renal disease. An association between a lower GD and progression was observed, especially in patients with persistent proteinuria of ≥1 g/day at follow-up. In contrast, any patients who achieved proteinuria of <1 g/day at follow-up did not show progression regardless of their GD levels. In addition, among the various clinicopathological factors observed, the GD was the only factor at biopsy that independently predicted the slope of the renal function during the observation periods.

Conclusion. These results suggest that low GD is a plausible risk factor for progression in IMN patients, especially in those that do not achieve a remission of proteinuria during the follow-up.

Keywords: glomerular density; membranous nephropathy; remission; renal biopsy; renal outcome

Journal Article.  3458 words.  Illustrated.

Subjects: Nephrology

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