title: Long-term outcomes of persistent disease and relapse in primary membranous nephropathy.
abstract: Primary membranous nephropathy is associated with variable clinical course ranging from spontaneous remission to slow progression to end stage renal failure. Achieving remission confers better renal survival in primary membranous nephropathy (PMN). Longer term outcomes such as patient survival and relapse of active disease remain poorly understood.
  
  
  
  We performed a retrospective study of 128 consecutive adult patients diagnosed with biopsy proven PMN at a single UK centre between 1980 and 2010. These patients were followed prospectively over a median of 128 months. We assessed impact of persistent disease and relapse on Stage 5 chronic kidney disease (CKD-5) and patient survival and present longer term cumulative incidences of different end points.
  
  
  
  One hundred patients achieved partial remission (PartRem) and 28 patients did not achieve remission (NoRem). Nine per cent of patients achieving first remission developed CKD-5 and 75% of those with NoRem developed CKD-5 [hazard ratio (HR) 0.07, 95% confidence interval 0.03-0.19). Relapse following PartRem occurred in 31 patients (31%) during follow-up and was significantly associated with progression to CKD-5. Progression to CKD-5 was strongly associated with death (47 versus 6%, HR 23.4; P < 0.01). Cumulative incidence at 15 years following first presentation included: death, 14%; CKD-5, 28%; and relapse 40% (in patients who achieved first remission).
  
  
  
  Our data strongly suggest that mortality in PMN is seen in patients with disease progression to CKD-5. Achieving remission is strongly associated with improved renal survival after first presentation and following relapse. We suggest that patients who achieve remission should be followed up in longer term, and better strategies to help improve outcomes are needed in clinical practice.
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.|Department of Renal Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Durga A K
authors.initials: DA
authors.lastname: Kanigicherla
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Short
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hamilton
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Milind
authors.initials: M
authors.lastname: Nikam
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Shelley
authors.initials: S
authors.lastname: Harris
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Paul E C
authors.initials: PE
authors.lastname: Brenchley
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Venning
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D015433:Glomerulonephritis, Membranous / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CKD-5; active disease; primary membranous nephropathy; relapse