Data_Sheet_1_Clinical Outcomes of Patients With Primary Membranous Nephropathy and Subnephrotic Proteinuria.PDF

Objectives: To update the information about the prognosis of patients with primary membranous nephropathy (MN) and subnephrotic proteinuria and identify the relevant predictors.
Methods: In total, 474 cases of biopsy-proven primary MN with at least 18 months of follow-up were reviewed to determine the outcomes of the subgroup of patients that presented with subnephrotic proteinuria. Clinical data included initial proteinuria and microhematuria, defined as the average proteinuria/microhematuria of the first 6 months during the course. Outcomes included partial remission (PR), complete remission (CR), nephrotic proteinuria progression, and kidney function progression, defined as ≥50% loss of kidney function or end-stage kidney disease.
Results: In total, 205 patients with primary MN and subnephrotic proteinuria at biopsy were eligible. During a median follow-up of 43 months, 200 (97.56%), 167 (81.46%), and 53 (25.85%) patients attained PR, CR, and nephrotic proteinuria progression, respectively. Only one patient (0.49%) progressed to the kidney function progression. By multivariate Cox hazards regression analyses, the initial proteinuria was identified as the independent predictor for PR, CR, and nephrotic proteinuria progression with adjusted hazard ratios (aHRs) of 0.67 (95% confidence interval, 0.56–0.80), 0.50 (95% CI, 0.40–0.63), and 2.97 (95% CI, 2.23–3.97), respectively. A higher level of initial microhematuria was also associated with an increased risk of nephrotic proteinuria progression. The corresponding aHR was 1.11 (95% CI, 1.05–1.17).
Conclusion: Among patients with primary MN and subnephrotic proteinuria, although the overall prognosis is excellent, dynamic detection and effective management of proteinuria remain important. In addition, initial microhematuria may be another predictor of nephrotic proteinuria progression.

研究目标：更新原发性膜性肾病（primary membranous nephropathy, MN）伴亚肾病范围蛋白尿患者的预后相关信息，并明确相关预测因子。

研究方法：本研究共回顾性分析474例经肾活检证实的原发性膜性肾病病例，所有病例均至少完成18个月的随访，旨在明确其中表现为亚肾病范围蛋白尿的亚组患者的转归情况。收集的临床资料包括初始蛋白尿与镜下血尿数据，以上指标取病程前6个月的平均水平进行计算。研究终点包括部分缓解（partial remission, PR）、完全缓解（complete remission, CR）、肾病范围蛋白尿进展，以及肾功能进展（定义为肾功能丧失≥50%或进展至终末期肾病）。

研究结果：最终纳入205例肾活检确诊为原发性膜性肾病且伴亚肾病范围蛋白尿的患者。中位随访时长为43个月，期间分别有200例（97.56%）、167例（81.46%）与53例（25.85%）患者达到部分缓解、完全缓解以及肾病范围蛋白尿进展；仅1例患者（0.49%）出现肾功能进展。经多因素Cox比例风险回归分析显示，初始蛋白尿水平是部分缓解、完全缓解及肾病范围蛋白尿进展的独立预测因子，校正后风险比（adjusted hazard ratios, aHRs）分别为0.67（95%置信区间（confidence interval, CI）：0.56~0.80）、0.50（95%置信区间（confidence interval, CI）：0.40~0.63）与2.97（95%置信区间（confidence interval, CI）：2.23~3.97）。初始镜下血尿水平升高同样与肾病范围蛋白尿进展风险升高相关，对应的校正后风险比为1.11（95%置信区间（confidence interval, CI）：1.05~1.17）。

研究结论：对于原发性膜性肾病伴亚肾病范围蛋白尿的患者而言，尽管整体预后良好，但动态监测与有效控制蛋白尿仍具有重要临床意义。此外，初始镜下血尿或可作为肾病范围蛋白尿进展的另一预测因子。