Bülent KAYA, Saime PAYDAŞ, Tolga KUZU, Mustafa BALAL

Membranöz Nefropatili Hastalarda Prognostik Faktörler

GİRİŞ ve AMAÇ: Membranöz nefropati (MN) yetişkinlerde nefrotik sendromun (NS) en yaygın nedenidir.Çalışmamızda MN’li hastalarda 1. yıl sonunda remisyonu etkileyen faktörleri belirlemeyi amaçladık. YÖNTEM ve GEREÇLER: Retrospektif çalışmamız, 2015-2018 yılları arasında MN tanısı almış, 18 yaş üstü hastalar üzerinde gerçekleştirildi. Hastalara ait tüm veriler hastanemiz medikal kayıtlarından elde edildi. MN hastaların başlangıç, 6., 12. ay laboratuvar değerleri (serum albümin, proteinüri, eGFR) ve 12. ay sonunda tedavi yanıt durumu değerlendirildi.. BULGULAR: Çalışmamızda ortalama yaşı 42.2±12.5 olan 24(%55.8)’u kadın 43 MN’li hasta üzerinde gerçekleştirildi. Hastalar 12 aylık tedavi süresinin sonunda remisyona giren (22, %51.2) ve girmeyen (21, %48.8) olmak üzere 2 gruba ayrıldı. Remisyon grubunda kadın cinsiyet daha fazla (p = 0,022), diyastolik kan basıncı daha düşük (p=0,025), mikofenolat kullanımı daha az (p=0,019), serum kreatinin daha düşük (p

Prognostic Factors in Membranous Nephropathy Patients

INTRODUCTION: Membranous nephropathy (MN) is the most common cause of nephrotic syndrome (NS) in adults. In our study, we aimed to determine the factors affecting remission in patients with MN at the end of the first year METHODS: Our retrospective study was performed on patients over 18 years of age diagnosed with MN between 2015-2018. In MN patients, baseline, 6th, 12th-month laboratory values (serum albumin, proteinuria, eGFR) and treatment response at the end of the 12th month was evaluated. RESULTS: Forty-three MN patients (24 (55.8%) women) with a mean age of 42.2±12.5 were evaluated. MN patients were divided into two groups at the end of the 12-month treatment period, remission and non-remission. In the remission group, female gender was higher (p=0.022), diastolic blood pressure was lower (p=0.025), mycophenolate use was less (p=0.019), serum creatinine was lower (p

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1.McGrogan A, Franssen CF, de Vries CS. The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrol Dial Transplant. 2011;26(2):414-30.
2.Turkmen A, Sumnu A, Cebeci E, Yazici H, Eren N, Seyahi N, et al. Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group. BMC Nephrol. 2020;21(1):481.
3.Donadio JV, Jr., Torres VE, Velosa JA, Wagoner RD, Holley KE, Okamura M, et al. Idiopathic membranous nephropathy: the natural history of untreated patients. Kidney Int. 1988;33(3):708-15.
4.Beck LH, Jr., Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361(1):11-21.
5.Tomas NM, Beck LH, Jr., Meyer-Schwesinger C, SeitzPolski B, Ma H, Zahner G, et al. Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy. N Engl J Med. 2014;371(24):2277-87.
6.Sethi S, Debiec H, Madden B, Charlesworth MC, Morelle J, Gross L, et al. Neural epidermal growth factor-like 1 protein (NELL-1) associated membranous nephropathy. Kidney Int. 2020;97(1):163-74.
7.Wasserstein AG. Membranous glomerulonephritis. J Am Soc Nephrol. 1997;8(4):664-74.
8.Sprangers B, Bomback AS, Cohen SD, Radhakrishnan J, Valeri A, Markowitz GS, et al. Idiopathic membranous nephropathy: clinical and histologic prognostic features and treatment patterns over time at a tertiary referral center. Am J Nephrol. 2012;36(1):78-89.
9.Tu WH, Petitti DB, Biava CG, Tulunay O, Hopper J, Jr. Membranous nephropathy: predictors of terminal renal failure. Nephron. 1984;36(2):118-24.
10.Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group: KDIGO clinical practice guideline for glomerulonephritis. Kidney Int 2012; 2(suppl 2): 139–274.
11.Floege J, Barbour SJ, Cattran DC, Hogan JJ, Nachman PH, Tang SCW, et al. Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;95(2):268-80.
12.Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55(4):622-7.
13.Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am J Kidney Dis. 2013;62(3):403-41.
14.Pei Y, Cattran D, Greenwood C. Predicting chronic renal insufficiency in idiopathic membranous glomerulonephritis. Kidney Int. 1992;42(4):960-6.
15.Polanco N, Gutierrez E, Rivera F, Castellanos I, Baltar J, Lorenzo D, et al. Spontaneous remission of nephrotic syndrome in membranous nephropathy with chronic renal impairment. Nephrol Dial Transplant. 2012;27(1):231-4.
16.du Buf-Vereijken PW, Branten AJ, Wetzels JF. Idiopathic membranous nephropathy: outline and rationale of a treatment strategy. Am J Kidney Dis. 2005;46(6):1012- 29.
17.Shiiki H, Saito T, Nishitani Y, Mitarai T, Yorioka N, Yoshimura A, et al. Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan. Kidney Int. 2004;65(4):1400-7.
18.Cattran DC, Pei Y, Greenwood CM, Ponticelli C, Passerini P, Honkanen E. Validation of a predictive model of idiopathic membranous nephropathy: its clinical and research implications. Kidney Int. 1997;51(3):901-7.
19.Thompson A, Cattran DC, Blank M, Nachman PH. Complete and Partial Remission as Surrogate End Points in Membranous Nephropathy. J Am Soc Nephrol. 2015;26(12):2930-7.
20.Laluck BJ, Jr., Cattran DC. Prognosis after a complete remission in adult patients with idiopathic membranous nephropathy. Am J Kidney Dis. 1999;33(6):1026-32.
21.Huh H, Lee H, Lee JP, Kim DK, Oh S, Oh YK, et al. Factors affecting the long-term outcomes of idiopathic membranous nephropathy. BMC Nephrol. 2017;18(1):104.
22.Troyanov S, Wall CA, Miller JA, Scholey JW, Cattran DC, Toronto Glomerulonephritis Registry G. Idiopathic membranous nephropathy: definition and relevance of a partial remission. Kidney Int. 2004;66(3):1199-205.
23.Reichert LJ, Koene RA, Wetzels JF. Prognostic factors in idiopathic membranous nephropathy. Am J Kidney Dis. 1998;31(1):1-11.
24.Cattran DC, Reich HN, Beanlands HJ, Miller JA, Scholey JW, Troyanov S, et al. The impact of sex in primary glomerulonephritis. Nephrol Dial Transplant. 2008;23(7):2247-53.
25.Schieppati A, Mosconi L, Perna A, Mecca G, Bertani T, Garattini S, et al. Prognosis of untreated patients with idiopathic membranous nephropathy. N Engl J Med. 1993;329(2):85-9.
26.Reckelhoff JF, Hennington BS, Moore AG, Blanchard EJ, Cameron J. Gender differences in the renal nitric oxide (NO) system: dissociation between expression of endothelial NO synthase and renal hemodynamic response to NO synthase inhibition. Am J Hypertens. 1998;11(1 Pt 1):97- 104.
27.Miller JA, Anacta LA, Cattran DC. Impact of gender on the renal response to angiotensin II. Kidney Int. 1999;55(1):278-85.
28.Branten AJ, du Buf-Vereijken PW, Vervloet M, Wetzels JF. Mycophenolate mofetil in idiopathic membranous nephropathy: a clinical trial with comparison to a historic control group treated with cyclophosphamide. Am J Kidney Dis. 2007;50(2):248-56.
29.Nikolopoulou A, Condon M, Turner-Stokes T, Cook HT, Duncan N, Galliford JW, et al. Mycophenolate mofetil and tacrolimus versus tacrolimus alone for the treatment of idiopathic membranous glomerulonephritis: a randomised controlled trial. BMC Nephrol. 2019;20(1):352.
30.Miller G, Zimmerman R, 3rd, Radhakrishnan J, Appel G. Use of mycophenolate mofetil in resistant membranous nephropathy. Am J Kidney Dis. 2000;36(2):250-6.
31.Lu W, Gong S, Li J, Wang Y. Clinicopathological features and prognosis in patients with idiopathic membranous nephropathy with hypertension. Exp Ther Med. 2020;19(4):2615-21.
32.Ihm CG. Hypertension in Chronic Glomerulonephritis. Electrolyte Blood Press. 2015;13(2):41-5.
33.Kutlugun AA, Tokgoz B, Sipahioglu MH, Oymak O, Utas C. Comparison of the clinical and laboratory presentations of primary and secondary glomerular diseases. Ren Fail. 2011;33(8):781-4.
34.Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, et al. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. WMJ. 2016;115(6):317-21.
35.Neale TJ, Ojha PP, Exner M, Poczewski H, Ruger B, Witztum JL, et al. Proteinuria in passive Heymann nephritis is associated with lipid peroxidation and formation of adducts on type IV collagen. J Clin Invest. 1994;94(4):1577- 84.
36.O'Donnell MP, Kasiske BL, Kim Y, Atluru D, Keane WF. Lovastatin inhibits proliferation of rat mesangial cells. J Clin Invest. 1993;91(1):83-7.
37.Takemura T, Yoshioka K, Aya N, Murakami K, Matumoto A, Itakura H, et al. Apolipoproteins and lipoprotein receptors in glomeruli in human kidney diseases. Kidney Int. 1993;43(4):918-27.
38.Keane WF, O'Donnell MP, Kasiske BL, Kim Y. Oxidative modification of low-density lipoproteins by mesangial cells. J Am Soc Nephrol. 1993;4(2):187-94.
39.Gupta S, Rifici V, Crowley S, Brownlee M, Shan Z, Schlondorff D. Interactions of LDL and modified LDL with mesangial cells and matrix. Kidney Int. 1992;41(5):1161-9.
40.Oda H, Keane WF. Recent advances in statins and the kidney. Kidney Int Suppl. 1999;71:S2-5.
41.Galle J, Heermeier K. Angiotensin II and oxidized LDL: an unholy alliance creating oxidative stress. Nephrol Dial Transplant. 1999;14(11):2585-9.
42.Bianchi S, Bigazzi R, Caiazza A, Campese VM. A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease. Am J Kidney Dis. 2003;41(3):565-70.
43.Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int. 1997;51(6):1908-19.
44.Ruggenenti P, Perna A, Tonelli M, Loriga G, Motterlini N, Rubis N, et al. Effects of add-on fluvastatin therapy in patients with chronic proteinuric nephropathy on dual reninangiotensin system blockade: the ESPLANADE trial. Clin J Am Soc Nephrol. 2010;5(11):1928-38. https://doi.org/10.4103/ijem.IJEM_183_18