Idiopathic membranous nephropathy: definition and relevance of a partial remission.
BACKGROUND
Membranous nephropathy (MGN) remains the most common cause of adult onset nephrotic syndrome, and within the primary glomerulonephritis group is a leading cause of renal failure. A complete remission (CR) confers an excellent long-term prognosis, but the quantitative benefits of partial remissions (PR) have not been defined.


METHODS
This study evaluated the rate of renal function decline (slope), relapse, and renal survival in nephrotic MGN patients with CR, PR, or no remission (NR). Multivariate analysis included clinical and laboratory data at presentation and over follow-up, blood pressure control and agents employed, and immunosuppressive therapy.


RESULTS
The study cohort consisted of 348 nephrotic MGN patients with a minimum of 12 months follow-up identified from the Toronto Glomerulonephritis Registry. Over a median follow-up of 60 months, 102 experienced a CR, 136 had a PR, and 110 had no remission. A PR was independently predictive of slope and survival from renal failure by multivariate analysis (hazard ratio 0.08, 95% CI 0.03-0.19, P < 0.001). Benefit from immunosuppression could only be shown in a subset of high-risk patients. Treatment-related PR had the same long-term implication as spontaneous ones. Relapses from PR were high (47%) but often reversible.


CONCLUSIONS
A partial remission is an important therapeutic target with implications for both progression rate and renal survival.
Department of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Stéphan
S
Troyanov
Catherine A
CA
Wall
Judith A
JA
Miller
James W
JW
Scholey
Daniel C
DC
Cattran
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D012008:Recurrence; D012042:Registries; D012074:Remission Induction; D016019:Survival Analysis
D007166:Immunosuppressive Agents