Analysis of the prognostic risk factors of idiopathic membranous nephropathy using a new surrogate end-point

Zhang,Bo; Cheng,Ming; Yang,Ming; Han,Shuai; Zhang,Ying-Hui; Shi,Hong-Guang; Zhu,Liang; Zhao,Xue-Zhi

doi:10.3892/br.2015.555

Analysis of the prognostic risk factors of idiopathic membranous nephropathy using a new surrogate end-point

Authors:
- Bo Zhang
- Ming Cheng
- Ming Yang
- Shuai Han
- Ying-Hui Zhang
- Hong-Guang Shi
- Liang Zhu
- Xue-Zhi Zhao
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Affiliations: Department of Gastroenterology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, P.R. China, Department of Nephrology, Changzheng Hospital Affiliated to the Second Military Medical University and the Kidney Institute of CPLA, Shanghai 200003, P.R. China, Department of Osteology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, P.R. China, Department of Nephrology, No. 401 Hospital of CPLA, Shandong 266000, P.R. China
Published online on: December 11, 2015 https://doi.org/10.3892/br.2015.555
Pages: 147-152
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Idiopathic membranous nephropathy (IMN) is one of the most common causes of nephrotic syndrome (NS) in adults. The latest study of the chronic kidney disease‑prognosis consortium showed that a 30% decrease in the estimated glomerular filtration rate (eGFR) within 2 years could cover more patients and showed a better correlation with end‑stage renal disease (ESRD), as compared with serum creatinine (SCr). The aim of the present study was to analyze prognostic factors of ESRD using a 30% decrease in eGFR within 2 years as the end‑point. The medical records of patients who were diagnosed as having IMN by clinical pathology between February 2011 and August 2012 and had been followed up for ≥24 months were analyzed retrospectively. A 30% decrease in eGFR or the occurrence of ESRD were the end‑points. Factors affecting the prognosis were analyzed by the χ2 test and multivariate logistic regression analysis, and the cumulative risk of risk factors was analyzed by Kaplan‑Meier curve. A total of 73 patients with IMN were confirmed by clinical pathology. Blood pressure, tubulointerstitial injury area (TIA), glomerular sclerosis ratio, SCr, blood urea nitrogen, cystatin C, serum albumin and 24‑h urine protein. In total, 28 patients (38.4%) reached the observation end‑point. Multivariate logistic regression analysis showed that only age ≥60 years, serum albumin <25 g/l and TIA >25% were independent risk factors for predicting the occurrence of end‑point events in the two groups (P<0.05), which increased the risk of the occurrence of end‑point events in IMN patients by 3.471‑, 3.195‑ and 6.724‑fold, respectively. Kaplan‑Meier curve showed that the occurrence of end‑point events within 2 years was significantly higher in IMN patients whose age was ≥60 years, serum albumin <25 g/l and TIA >25% (log‑rank P=0.004, P=0.024 and P=0.001). The results of the present study revealed that age ≥60 years, low serum albumin concentrations and severe tubulointerstitial injury are independent risk factors for the occurrence of ESRD in IMN patients.

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