title: Prognostic significance of glomerular and tubulointerstitial morphometry in idiopathic membranous nephropathy.
abstract: The purpose of our study was to investigate the prognostic value of clinical and pathological, in particular glomerular and tubulointerstitial morphometric variables in idiopathic membranous nephropathy (IMN). We prospectively followed 60 Caucasian patients diagnosed with idiopathic membranous nephropathy for at least 2 years or until primary outcome (≥50% permanent decrease in estimated glomerular filtration rate or death). Glomerular and tubulointerstitial morphometric variables at the time of renal biopsy were analyzed with respect to this outcome. Univariate analysis revealed that significant negative prognostic factors for this outcome were higher cholesterol and smaller albumin concentrations, higher creatinine and maximal 24-h proteinuria, higher grade of nephroangiosclerosis, higher glomerular basement membrane thickness and glomerulopathy index, higher interstitial fibrosis and tubular atrophy percentage and higher injury score. In multivariate analysis, only the maximal 24-h proteinuria and interstitial fibrosis and tubular atrophy percentage were independent predictors of this outcome. The results suggest that morphometric analysis, mainly quantitative measurement of interstitial fibrosis and tubular atrophy percentage, injury score, glomerular basement membrane thickness and glomerulopathy index could be used as an additional method for risk stratification of patients with idiopathic membranous nephropathy.
authors.affiliation: Department of Nephrology, Dubrava University Hospital, Zagreb, Croatia. ivica.horvatic@yahoo.com
authors.forename: Ivica
authors.initials: I
authors.lastname: Horvatic
authors.forename: Danica Galesic
authors.initials: DG
authors.lastname: Ljubanovic
authors.forename: Stela
authors.initials: S
authors.lastname: Bulimbasic
authors.forename: Mladen
authors.initials: M
authors.lastname: Knotek
authors.forename: Ingrid
authors.initials: I
authors.lastname: Prkacin
authors.forename: Miroslav
authors.initials: M
authors.lastname: Tisljar
authors.forename: Kresimir
authors.initials: K
authors.lastname: Galesic
mesh_terms: D019963:Clinical Chemistry Tests; D017523:Croatia / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D007678:Kidney Glomerulus / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents