title: Out of Africa: Complete and partial remissions as a combined outcome in patients with idiopathic membranous glomerulonephritis in Cape Town.
abstract: OBJECTIVE
  Remission outcomes among patients with idiopathic membranous glomerulonephritis is unknown in Africa. We sought to determine remission outcomes in a cohort of South African adult patients with IMGN.
  
  
  METHODS
  This was a retrospective review of patients with biopsy-proven IMGN over a 10 year period. Secondary causes of MN were excluded. Demographic, clinical, biochemical and histological records were retrieved for analysis. The trends in biochemical parameters from baseline were determined. The primary outcome was the attainment of a complete or partial remission (CR / PR) at the last follow-up.
  
  
  RESULTS
  Fifty-six patients met the criteria for inclusion and 43 had subsequent follow-up care with a median duration of follow-up of 23.0 (13.0-48.0) months. Sixteen patients (37.2%) were treated with immunosuppression (corticosteroids and cyclophosphamide) and 81.4% received anti-proteinuric agents. There were no significant differences in demographic and clinical features of patients categorized by immunosuppression (ISP) use. Changes in level of proteinuria and estimated glomerular filtration rate (eGFR) were also not significantly different between the two groups. Eighteen patients (41.9%) reached CR or PR at the last visit. The median times-to-remission of patients according to ISP status were similar at 48.6 and 48.7 months respectively (P = 0.104) while the proportions of patients not reaching CR/PR at 12 and 24 months were 94.6% and 80.8% respectively. Gender and race did not predict remission status (P > 0.05). Predictors of CR/PR at last visit were eGFR [OR 1.01 (95%CI: 1.00 - 1.02); P = 0.041], and systolic BP (OR 0.97 [95%CI: 0.95 - 0.99); P = 0.036].
  
  
  CONCLUSIONS
  Remission outcomes in this African IMGN cohort are delayed and poor.
authors.affiliation: Division of Nephrology and Hypertension, Groote Schuur Hospital and Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Oluwatoyin I
authors.initials: OI
authors.lastname: Ameh
authors.affiliation: Division of Nephrology and Hypertension, Groote Schuur Hospital and Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Swanepoel
authors.affiliation: AB Consultants Medical Centre, Ilorin, Nigeria.
authors.forename: Ademola
authors.initials: A
authors.lastname: Aderibigbe
authors.affiliation: Medical Research Council, South Africa, Non-Communicable Diseases Research Unit, Cape Town, South Africa.
authors.forename: Andre P
authors.initials: AP
authors.lastname: Kengne
authors.affiliation: Division of Nephrology and Hypertension, Groote Schuur Hospital and Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Ikechi G
authors.initials: IG
authors.lastname: Okpechi
mesh_terms: D000328:Adult; D001706:Biopsy; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: South Africa; immunosuppression; membranous glomerulonephritis; remission