title: [Management of idiopathic membranous nephropathy: evaluation of a standardized strategy in a Lorraine health network].
abstract: BACKGROUND
  The evolution of idiopathic membranous membranous (MNi) is variable, treatment is discussed. Our work's main objective was to evaluate the results of a standardized management strategy proposed in 2006 in Lorraine (Nephrolor health network). The secondary objective was to evaluate the professional practices.
  
  
  METHODS
  This study compared the evolution of incident MNi between 2002 and 2005 (Before) and between 2007 and 2010 (After), the respective dates point to 31/12/2011 and 31/12/2006. In nephrotics patients without renal failure, the risk assessment of end stage renal disease based on urinary β2-microglobulin (uβ2 m, threshold to 0,5 μg/min). Patients at high risk should receive immunosuppressive therapy (IS).
  
  
  RESULTS
  Seventy-four biopsy-proven MNi were diagnosed with 50 nephrotic (22 Before and 28 After) of which 20 had normal renal function. In these nephrotic, there was no significant difference in the probability and the average time of remission between the two groups (P=0.26). Dosage of uβ2m was performed in 35% of cases. Fifty percent were treated with IS respecting strategy.
  
  
  CONCLUSIONS
  Despite differences between the strategy and practices, which may explain these non-significant results, we observed changes in thinking and therapeutic attitude of the clinician. The implementation of this strategy tends to standardize and improve practices about MNi in Lorraine, which seems to improve results in remission. We encourage to generalize the application of this strategy and to continue this cohort follow.
authors.affiliation: Service de néphrologie, CHU Nancy Brabois Adultes, rue du morvan, 54500 Vandœuvre-lès-Nancy, France. Electronic address: aubertinperrine@yahoo.fr.
authors.forename: Perrine
authors.initials: P
authors.lastname: Aubertin
authors.affiliation: Réseau Néphrolor, 54500 Vandoeuvre-lès-Nancy, France; Pôle S2R, épidémiologie et évaluation cliniques, CHU de Nancy, ESPRI, 54000 Nancy, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ayav
authors.affiliation: Service de néphrologie, hôpitaux privés de Metz-Hôpital Robert-Schuman, rue du Champs-Montoy, Parvis-Robert-Schuman, 57070 Vantoux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Stolz
authors.affiliation: Service de néphrologie, CHU Nancy Brabois Adultes, rue du morvan, 54500 Vandœuvre-lès-Nancy, France; Réseau Néphrolor, 54500 Vandoeuvre-lès-Nancy, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.affiliation: Département d'anatomie et cytologie pathologiques, CHU Nancy Brabois Adultes, rue du morvan, 54500 Vandœuvre-lès-Nancy, France.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Champigneulle
authors.affiliation: Laboratoire de pathologie, 21, rempart Saint-Thiebault, 57000 Metz, France.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aymard
authors.affiliation: Service de néphrologie, CHU Nancy Brabois Adultes, rue du morvan, 54500 Vandœuvre-lès-Nancy, France; Réseau Néphrolor, 54500 Vandoeuvre-lès-Nancy, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
mesh_terms: D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D005938:Glucocorticoids
keywords: Glomérulonéphrite extramembraneuse; Immunosuppressive therapy; Membranous nephropathy; Professional practice assessment; Remission; Rémission; Traitement immunosuppresseur; Évaluation des pratiques professionnelles