title: Pathological predictors of renal outcomes in nephrotic idiopathic membranous nephropathy with decreased renal function.
abstract: OBJECTIVE
  The outcome of idiopathic membranous nephropathy (IMN) in adults with nephrotic-range proteinuria and decreased renal function has seldom been described and the predictive value of pathological features is debated. This study aimed to describe the clinical course of this patient subgroup and to identify independently predictive pathological features.
  
  
  METHODS
  We evaluated 129 adults with biopsy-proven IMN diagnosed from 2002 to 2011. All patients had chronic kidney disease (CKD) stages 2-4 and nephrotic-range proteinuria (≥3.5 g/day). Primary outcomes were a 20 or 50 % decline in renal function, progression to end-stage renal disease (ESRD), or all-cause mortality.
  
  
  RESULTS
  Of 129 patients, 38 (30 %) presented with proteinuria ≥8.0 g/day and 37 (29 %) with CKD stages 3-4. Thirteen (10 %) presented with segmental sclerosis, 97 (75 %) with arteriosclerosis, 42 (33 %) with moderate-to-severe tubulointerstitial injury, and 86 (67 %) with C3 deposition. Over a median follow-up of 34 months (range 12-135), 51 patients (40 %) had a 20 % decline in renal function, 27 (21 %) a 50 % decline, 14 (11 %) developed ESRD, and 19 (15 %) died. Segmental sclerosis and tubulointerstitial injury but not arteriosclerosis or C3 deposition were independent risk factors for 20 and 50 % renal function decline and progression to ESRD.
  
  
  CONCLUSIONS
  Segmental sclerosis and tubulointerstitial injury predict renal outcomes independent of clinical data in nephrotic IMN patients with decreased renal function.
authors: Division of Nephrology, State Key Discipline of Internal Medicine (Nephrology), State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Medical Research Center for Kidney Disease (2013BAI09B05), Medical Quality Control Center for Kidney Disease, Chinese People's Liberation Army (PLA) General Hospital (301 Hospital), Chinese PLA Medical Academy, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China.
authors: Yizhi
authors: Y
authors: Chen
authors: Li
authors: L
authors: Tang
authors: Zhe
authors: Z
authors: Feng
authors: Xueying
authors: X
authors: Cao
authors: Xuefeng
authors: X
authors: Sun
authors: Moyan
authors: M
authors: Liu
authors: Shuwen
authors: S
authors: Liu
authors: Xueguang
authors: X
authors: Zhang
authors: Ping
authors: P
authors: Li
authors: Ribao
authors: R
authors: Wei
authors: Qiang
authors: Q
authors: Qiu
authors: Guangyan
authors: G
authors: Cai
authors: Xiangmei
authors: X
authors: Chen
mesh_terms: D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D015433:Glomerulonephritis, Membranous / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000209:etiology / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012598:Sclerosis; D013997:Time Factors