Outcome of Idiopathic Membranous Nephropathy: A Retrospective Study.

BACKGROUND: Idiopathic membranous nephropathy (IMN) is one of the most common causes of nephrotic syndrome (NS) in Caucasian adults. Most patients have good renal prognosis, but 30-40% may progress to end stage renal disease (ESRD). OBJECTIVES: To evaluate the efficacy and safety of immunosuppressive treatment (IST) in high-risk patients. METHODS: All IMN patients diagnosed by kidney biopsy from 2004-2010 were included. Clinical and laboratory data were collected at each follow-up visit. Risk assessment for renal progression classified patients as high risk if: 24 hour protein excretion > 6 g/day, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, and severe disabling or life-threatening clinical symptoms of NS were present. RESULTS: Among 290 biopsies, 37 patients (12.7%) were IMN. They were allocated to the high-risk IST group (n=16) or low-risk supportive treatment (ST) group (n=21) according to the likelihood of developing renal failure. Mean follow-up was 47 ± 17.3 months. Complete and partial remission rate was 68.7% for high-risk IST vs. 90.4% for low-risk ST. In the high-risk IST group, eGFR was significantly lower at 30 months (65.5 ± 28.6 vs. 85.3 ± 21.6 at baseline, P < 0.05). Four high-risk patients reached ESRD. In the low-risk ST group, eGFR remained stable at 30 and 60 months. CONCLUSIONS: This study showed a high remission rate for IMN. IST with prednisolone and cyclophosphamide provided favorable renal outcomes in most high-risk patients. The very high remission rate obtained in the low-risk patients confirms the adequacy of supportive treatment in this group.

[THE SPECTRUM OF RENAL DISEASE IN KIDNEY BIOPSIES OF DIABETIC PATIENTS: A SINGLE CENTER EXPERIENCE].

BACKGROUND: Kidney biopsies are not routinely performed for diabetic patients with chronic kidney disease. However in some cases, a biopsy is carried out to exclude other treatable Prolonged duration of diabetes, insulin therapies and presence of diabetic retinopathy were associated with a greater likelihood of DN. The high prevalence of NDRD in our population emphasizes the judicious use of kidney biopsy in diabetic patients. e renal diseases. The prevalence and the nature of non diabetic renal disease (NDRD) among diabetic patients in Israel have not yet been evaluated. OBJECTIVE: To assess pathological findings of kidney biopsies conducted in patients with diabetes mellitus. METHODS: A total of 200 native kidney biopsies were performed during the study period. Patients who had a diagnosis of diabetes mellitus were included in the study. Clinical data and pathological findings were retrospectively collected and analyzed. RESULTS: The cohort included 34 patients, median age 61.8 years. The male to female ratio was 25:9; mean serum creatinine was 1.8 ± 1.2 mg/dl The duration of diabetes was significantly shorter in patients with NDRD (6.8 ± 7.1 years vs. 13.0 ± 9.6 years in diabetic nephropathy (DN) or combined), whereas insulin therapy was significantly more common in patients with DN (72% vs 5% in NDRD). Diabetic retinopathy was documented in 57% of patients with diabetic nephropathy but wasn't documented in any patient with NDRD. Prevalence of NDRD, DN and combined pathology was 58.8%, 32.4% and 8.8% respectively. Neither the level of proteinuria nor the rate of renal function deterioration could predict pathological findings in the biopsy. The most common NDRD disease was nephrosclerosis. CONCLUSIONS: Non-diabetic renal disease was common. Prolonged duration of diabetes, insulin therapies and presence of diabetic retinopathy were associated with a greater likelihood of DN. The high prevalence of NDRD in our population emphasizes the judicious use of kidney biopsy in diabetic patients.