Idiopathic membranous nephropathy with focal segmental sclerosis

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Abstract

Aim. To evaluate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental sclerosis (FSGS) in a group of Russian patients.

Materials and methods. 101 patients with morphologically verified IMN were enrolled in our single-center cohort retrospective study. The patients were divided into IMN group and IMN+FSGS group. The primary and secondary outcomes were analyzed in 59 patients, which had follow-up data for period more than 6 months.

Results. At the time of renal biopsy the median age was 46.0 (33.0; 55.0) years and the median follow-up was 6.8 (4.0; 15.6) months. Secondary FSGS was revealed in 15 (14.9%) patients with IMN. The IMN and IMN+FSGS groups did not differ in gender, age of onset IMN and age of renal biopsy. In the IMN+FSGS group proteinuria was higher and estimated glomerular filtration rate was lower than that in the IMN group (p<0.05). The systolic arterial pressure and creatinine levels in the IMN+FSGS group were slightly higher than in the IMN group, but the difference was not significant. Anti-PLA2R positivity was similar in both groups. Chronic kidney disease (CKD) progression was observed in 10/52 (19.2%) and 5/7 (71.4%) patients in IMN and IMN+FSGS groups, respectively. In a multivariate Cox regression model, age of renal biopsy (odds ratio – OR 1.12, 95% confidence interval – CI 1.03–1.22; р=0.07), FSGS (OR 0.05, 95% CI 0.01–0.34; р=0.002) и response to initial course of immunosuppression (OR 0.33, 95% CI 0.12–0.95; р=0.039) were associated with the CKD progression.

Conclusion. In patients with IMN secondary FSGS is associated with a greater severity of proteinuria and a decrease in estimated glomerular filtration rate, and is also an independent factor of the CKD progression.

About the authors

Elena S. Kamyshova

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0000-0002-1823-0125

канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Irina N. Bobkova

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0000-0002-8007-5680

д-р мед. наук, проф. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Patimat А. Kakhsurueva

Municipal Polyclinic No. 134

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0009-0002-6138-870X

врач-нефролог

Russian Federation, Moscow

Amnat S. Abdulaeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0009-0003-3908-9313

ординатор каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Tatiana Е. Rudenko

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0000-0002-1296-4494

канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Ekaterina V. Stavrovskaya

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0000-0001-6381-2186

канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Elena Yu. Andreeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0009-0003-6188-1075

канд. мед. наук, врач-нефролог Университетской клинической больницы №3

Russian Federation, Moscow

Olga А. Li

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0000-0003-1739-677X

канд. мед. наук, зав. нефрологическим отд-нием Университетской клинической больницы №3

Russian Federation, Moscow

Aleksandr Yu. Suvorov

Sechenov First Moscow State Medical University (Sechenov University)

Email: kamyshova_e_s@staff.sechenov.ru
ORCID iD: 0000-0002-2224-0019
Russian Federation, Moscow

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2. Fig. 1. Chronic kidney disease progression in idiopathic membranous nephropathy with focal segmental sclerosis groups. Kaplan–Meier survival curves.

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