Clinicopathological and long-term prognostic features of membranous nephropathy with crescents: a Japanese single-center experience View Full Text


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Article Info

DATE

2017-08-29

AUTHORS

Masaya Saito, Atsushi Komatsuda, Ryuta Sato, Ayano Saito, Hajime Kaga, Fumito Abe, Masato Sawamura, Mizuho Nara, Masaru Togashi, Shin Okuyama, Hideki Wakui, Naoto Takahashi

ABSTRACT

BackgroundThree recent studies from the United States and China reported the clinicopathological features and short-term prognosis in patients with membranous nephropathy (MN) and crescents in the absence of secondary MN, anti-glomerular basement membrane (GBM) antibodies, and anti-neutrophil cytoplasmic antibodies (ANCA).MethodsWe compared clinicopathological and prognostic features in 16 MN patients with crescents (crescent group) and 38 MN patients without crescents (control group), in the absence of secondary MN, anti-GBM antibodies, and ANCA. Median follow-up periods in the crescent and control groups were 79 and 50 months, respectively.ResultsDecreased estimated glomerular filtration rates (<50 mL/min/1.73 m2), glomerulosclerosis, and moderate-to-severe interstitial fibrosis were more frequently observed in the crescent group than in the control group (P = 0.043, P = 0.004, and P = 0.035, respectively). Positive staining rates for glomerular IgG2 and IgG4 were significantly different between the 2 groups (P = 0.032, P = 0.006, respectively). Doubling of serum creatinine during follow-up was more frequently observed in the crescent group than in the control group (P = 0.002), although approximately two-thirds of patients in the crescent group were treated with immunosuppressive therapy. Crescent formation and interstitial fibrosis were risks for doubling of serum creatinine [hazard ratio (HR) = 10.506, P = 0.012; HR = 1.140, P = 0.009, respectively].ConclusionsThis is the first Japanese study demonstrating significant differences in clinicopathological and prognostic features between the 2 groups. Most patients in the crescent group may develop a long-term decline in renal function despite immunosuppressive therapy. More... »

PAGES

365-376

References to SciGraph publications

  • 2014-11-21. Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy in CLINICAL AND EXPERIMENTAL NEPHROLOGY
  • 2013-11-12. Membranous glomerulonephritis with crescents in INTERNATIONAL UROLOGY AND NEPHROLOGY
  • 2016-04-26. Long-term prognosis of AL and AA renal amyloidosis: a Japanese single-center experience in CLINICAL AND EXPERIMENTAL NEPHROLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s10157-017-1465-y

    DOI

    http://dx.doi.org/10.1007/s10157-017-1465-y

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1091380537

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28852884


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    32 schema:description BackgroundThree recent studies from the United States and China reported the clinicopathological features and short-term prognosis in patients with membranous nephropathy (MN) and crescents in the absence of secondary MN, anti-glomerular basement membrane (GBM) antibodies, and anti-neutrophil cytoplasmic antibodies (ANCA).MethodsWe compared clinicopathological and prognostic features in 16 MN patients with crescents (crescent group) and 38 MN patients without crescents (control group), in the absence of secondary MN, anti-GBM antibodies, and ANCA. Median follow-up periods in the crescent and control groups were 79 and 50 months, respectively.ResultsDecreased estimated glomerular filtration rates (<50 mL/min/1.73 m2), glomerulosclerosis, and moderate-to-severe interstitial fibrosis were more frequently observed in the crescent group than in the control group (P = 0.043, P = 0.004, and P = 0.035, respectively). Positive staining rates for glomerular IgG2 and IgG4 were significantly different between the 2 groups (P = 0.032, P = 0.006, respectively). Doubling of serum creatinine during follow-up was more frequently observed in the crescent group than in the control group (P = 0.002), although approximately two-thirds of patients in the crescent group were treated with immunosuppressive therapy. Crescent formation and interstitial fibrosis were risks for doubling of serum creatinine [hazard ratio (HR) = 10.506, P = 0.012; HR = 1.140, P = 0.009, respectively].ConclusionsThis is the first Japanese study demonstrating significant differences in clinicopathological and prognostic features between the 2 groups. Most patients in the crescent group may develop a long-term decline in renal function despite immunosuppressive therapy.
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    40 IgG2
    41 IgG4
    42 Japanese single-center experience
    43 Japanese studies
    44 MN patients
    45 MethodsWe
    46 Recent studies
    47 United States
    48 absence
    49 anti-GBM antibodies
    50 anti-glomerular basement membrane antibodies
    51 anti-neutrophil cytoplasmic antibodies
    52 antibodies
    53 basement membrane antibodies
    54 clinicopathological features
    55 control group
    56 creatinine
    57 crescent formation
    58 crescent group
    59 crescents
    60 cytoplasmic antibodies
    61 decline
    62 differences
    63 doubling
    64 experience
    65 features
    66 fibrosis
    67 filtration rate
    68 first Japanese study
    69 formation
    70 function
    71 glomerular filtration rate
    72 glomerulosclerosis
    73 group
    74 immunosuppressive therapy
    75 interstitial fibrosis
    76 long-term decline
    77 membrane antibodies
    78 membranous nephropathy
    79 months
    80 most patients
    81 nephropathy
    82 patients
    83 period
    84 positive staining rate
    85 prognosis
    86 prognostic features
    87 rate
    88 renal function
    89 risk
    90 secondary membranous nephropathy
    91 serum creatinine
    92 severe interstitial fibrosis
    93 short-term prognosis
    94 significant differences
    95 single-center experience
    96 staining rate
    97 state
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