Post Date December, 03 2023
Membrane nephropathy is one of the most common types of diseases leading to adult nephrotic syndrome.
Nephrotic syndrome is a group of clinical manifestations and is not an independent disease name. It can be called nephrotic syndrome as long as it meets the two conditions of large amount of proteinuria (24h ration is more than 3.5g) and hypoproteinemia (serum albumin is less than 30g/L). Nephrotic syndrome is often accompanied by high blood fat, edema and other manifestations.
Many disease types, such as minor lesions, diabetes nephropathy, FSGS, etc., can lead to nephrotic syndrome. According to data statistics, about one of the three kidney punctures in adult nephrotic syndrome results in membranous nephropathy.
Adult membranous nephropathy is usually primary (also called idiopathic), which means that secondary factors are excluded. Primary membranous nephropathy accounts for about 75% of all membranous nephropathy.
However, 80% of primary membranous nephropathy starts with nephrotic syndrome, and the rest is non-nephrotic proteinuria (less than 3.5g/day).
Let's look at the factors that affect the prognosis of primary membranous nephropathy.
1 Clinical indicators
Clinical indicators suggest that membranous nephropathy will deteriorate progressively, mainly including:
1) The patient was older at the time of onset (>50 years old);
2) Male;
3) Continuous proteinuria at nephrotic level (more than 3.5g/day), especially urinary protein more than 8g/day;
4) At the time of onset, serum creatinine has increased;
2 Pathology
The discovery of renal puncture histology is usually regarded as an important predictor of prognosis. When severe interstitial fibrosis and renal tubular atrophy are seen in the pathology of patients with membranous nephropathy, the prognosis of patients is poor. The severity of renal tubulointerstitial injury is more closely related to the prognosis than glomerular injury.
Because more obvious renal tubulointerstitial injury is usually associated with old age, high mean arterial pressure and low creatinine clearance. Although renal tubulointerstitial injury is related to the decline of renal life, it cannot be predicted independently of the baseline clinical indicators, that is to say, pathology needs to be combined with clinical indicators and cannot be used as a prognostic indicator alone.
3 Treatment response
Complete remission of membranous nephropathy: protein is less than 0.3g/day (the standard is reached at least twice a week), serum albumin is normal, and creatinine is normal;
Partial remission: urine protein decreased by more than 50% and urine protein was between 0.3-3.5g (at least twice a week to reach the standard), and albumin was normal or improved, and creatinine was stable.
Even if there is no treatment or conservative treatment, about 5% - 30% of people will completely relieve themselves within 5 years; 25% - 40% of patients will have partial remission within 5 years (reaching protein content<2g/d).
There was a follow-up study of 37 patients with membranous nephropathy who were not treated for about 5 years. Of these 37 patients, 65% had complete or partial remission, and 16% had advanced to end-stage renal failure.
Because membranous nephropathy has the tendency of spontaneous remission, doctors will select patients with low and moderate risk through the risk prediction of different patients, and use conservative treatment during the observation period (generally 6 months, some cases will extend the observation period), that is, only RAS blockers (pril and sartan), lipid-lowering drugs, etc., instead of hormones and immunosuppressants.
For those patients with high risk of renal function progression, active treatment (hormone and immunosuppressive agent) should be selected instead of conservative treatment.
For membranous nephropathy, both spontaneous remission and drug-induced remission indicate a good long-term prognosis.
