Abeesh, P (2014) Clinical profile, clinicopathological correlation and outcome of adult membranous nephropathy. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND : Membranous nephropathy (MN) is one of the most common causes of primary glomerulopathy causing nephrotic syndrome in adults. Primary membranous nephropathy is the common type accounting for 75-80%. Remaining 20% -25% can be secondary to systemic autoimmune disorders like systemic lupus erythematosis, chronic infections like hepatitis B and hepatitis C, malignancy and variety of drugs. This study is aimed at analyzing the profile of membranous nephropathy in South Indian population as there is limited information in this regard. METHODS : In this prospective observational study, we included 98 biopsy proven MN patients. Five patients were excluded from the study, as they had end stage renal disease at the time of presentation. Remaining 93 patients were categorized as primary and secondary after screening for the possible causes of MN. The epidemiological profile of study population was analyzed. The clinical, biochemical and histopathological parameters among primary and secondary MN patients were compared. The response rate & predictors of response to immunosuppressive treatment evaluated. The risk factors for progression to chronic kidney disease were also analyzed. RESULTS : After screening for secondary causes 56/93 (60%) were diagnosed as primary MN and remaining 37/93 (40%) were secondary MN. The underlying causes of secondary MN patients were lupus nephritis (n=28), malignancy (n=3), hepatitis B virus (n=2) rheumatoid arthritis (n=1), and native drugs (n=3). Most of our primary MN patients were within 40-60 years of age 55% (31/56) and 66% (37/56) of primary MN were males. Primary MN patients had severe disease at the time of presentation when compared to the secondary MN patients (uPCR 4.75mg/mg vs.3.60 mg/mg, p=<0.001; serum albumin 3.07g/dl vs.3.49 g/dl p=<0.001; serum cholesterol 224 mg/dl vs. 184mg/dl p=<0.001).Fifty seven percent (21/37) of secondary MN had at least 1+ C1q staining when compared to 7% ( 4/56) in those with primary disease. Out of 56 primary MN patients, 30 % (17/56) of patients achieved remission. Out of 33 patients who received modified Ponticelli regimen 24 % (8/33) achieved remission. Spontaneous remission occurred in 9 out of these 14 patients (64%) who were under conservative therapy. Patients who had not remitted had severe disease when compared to those who remitted. (uPCR 5.3 mg/mg vs. 3.3 mg/mg p=<0.001; serum albumin 2.8 g/dl vs. 3.47 g/dl p=<0.001; serum cholesterol 241mg/dl vs.184mg/dl p=0.0017). During the follow up of 56 primary MN patients, (median follow up period was 18 months), 10 % (6/56) of them developed progressive renal failure. Out of the 6 patients who progressed to renal failure, 67% (4/6) had interstitial fibrosis and tubular atrophy of >25% when compared to 6% (3/50) in those who had stable renal function. Five out of 6 (83%) patients progressing to renal failure had nephrotic proteinuria as compared to 37 out of 50 patients (74%) having stable renal function. Only one patient out of 6 patients who progressed to renal failure had remitted (16%) as compared to 16 out of 50 (32%) in stable renal function group. CONCLUSION : Primary MN was more common than secondary MN in our study accounting for about 60%. Primary MN was common within 40-60 years of age and males were commonly affected than females. Primary MN had severe disease at the time of presentation. C1q staining in the biopsy was more common in secondary MN Patients having severe disease at the time of presentation had poor remission rate (both in conservative and immunosuppressive therapy) when compared to those with mild disease. Interstitial fibrosis and tubular atrophy of >25% in the initial biopsy picture was a definite risk factor for progression to renal impairment. Patients with nephrotic proteinuria and those who did not remit had higher rate for progression to chronic kidney disease (not statistically significant) in our study.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical profile ; clinicopathological correlation ; adult membranous ; nephropathy. |
| Subjects: | MEDICAL > Nephrology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 11 Jul 2017 05:20 |
| Last Modified: | 11 Jul 2017 05:20 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1378 |
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