title: Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy.
abstract: Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 +/- 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission.
authors.affiliation: Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Polanco
authors.forename: Elena
authors.initials: E
authors.lastname: Gutiérrez
authors.forename: Adelardo
authors.initials: A
authors.lastname: Covarsí
authors.forename: Francisco
authors.initials: F
authors.lastname: Ariza
authors.forename: Agustín
authors.initials: A
authors.lastname: Carreño
authors.forename: Ana
authors.initials: A
authors.lastname: Vigil
authors.forename: José
authors.initials: J
authors.lastname: Baltar
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Fresnedo
authors.forename: Carmen
authors.initials: C
authors.lastname: Martín
authors.forename: Salvador
authors.initials: S
authors.lastname: Pons
authors.forename: Dolores
authors.initials: D
authors.lastname: Lorenzo
authors.forename: Carmen
authors.initials: C
authors.lastname: Bernis
authors.forename: Pilar
authors.initials: P
authors.lastname: Arrizabalaga
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Juárez
authors.forename: Vicente
authors.initials: V
authors.lastname: Barrio
authors.forename: Milagros
authors.initials: M
authors.lastname: Sierra
authors.forename: Ines
authors.initials: I
authors.lastname: Castellanos
authors.forename: Mario
authors.initials: M
authors.lastname: Espinosa
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivera
authors.forename: Aniana
authors.initials: A
authors.lastname: Oliet
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Vega
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
mesh_terms: D015331:Cohort Studies; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000628:therapy; D011507:Proteinuria / Q000209:etiology; D012075:Remission, Spontaneous; D012189:Retrospective Studies