Anti-phospholipase A2 receptor positive membranous nephropathy: investigating the link between electron microscopy stages and clinical outcome.

IF 1.1 4区 医学 Q4 MICROSCOPY Ultrastructural Pathology Pub Date : 2023-09-03 DOI:10.1080/01913123.2023.2236225
Gabriel Stefan, George Terinte Balcan, Nicoleta Petre, Simona Cinca, Adrian Zugravu, Simona Stancu
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引用次数: 1

Abstract

This retrospective, observational study sought to examine the relationship between Ehrenreich-Churg electron microscopy (EM) stages and long-term outcomes in anti-PLA2R membranous nephropathy (MN). Seventy-one patients with anti-PLA2R MN (median titer 185.7RU/mL) were followed for a median of 46 months, with end-stage kidney disease (ESKD) as the primary endpoint, and response to treatment as a secondary endpoint. Patients were grouped into stages I-II (41 patients) and stages III-IV (30 patients) for analytical purposes. Notably, the III-IV group demonstrated a lower eGFR, lower anti-PLA2R titer, but a higher chronicity score. Kaplan-Meier analysis showed shorter mean kidney survival time in stages III-IV compared to I-II (p 0.03). However, multivariate analysis using Cox regression indicated that Ehrenreich-Churg stages did not significantly influence kidney survival, but lower eGFR at diagnosis and higher histopathological chronicity score did. Remission was achieved by 64% of patients and no relationship between Ehrenreich-Churg stages and treatment response was found. The only identified risk factor for not achieving remission was the severity of hyposerinemia at diagnosis. In conclusion, while EM stages III-IV are associated with more chronic lesions and stages I-II with more active immunologic disease, the histological chronicity score seems to be a stronger predictor of long-term outcomes.

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抗磷脂酶A2受体阳性膜性肾病:探讨电镜分期与临床预后之间的联系。
这项回顾性观察性研究旨在研究抗pla2r膜性肾病(MN)的Ehrenreich-Churg电子显微镜(EM)分期与长期预后之间的关系。71例抗pla2r MN患者(中位滴度为185.7RU/mL)随访中位时间为46个月,以终末期肾病(ESKD)为主要终点,对治疗的反应为次要终点。为了分析目的,将患者分为I-II期(41例)和III-IV期(30例)。值得注意的是,III-IV组表现出较低的eGFR,较低的抗pla2r滴度,但较高的慢性评分。Kaplan-Meier分析显示,与I-II期相比,III-IV期的平均肾脏生存时间更短(p < 0.03)。然而,采用Cox回归的多变量分析表明,Ehrenreich-Churg分期对肾脏生存没有显著影响,但诊断时较低的eGFR和较高的组织病理学慢性评分对肾脏生存有显著影响。64%的患者获得缓解,Ehrenreich-Churg分期与治疗反应没有关系。唯一确定的未达到缓解的危险因素是诊断时低丝氨酸血症的严重程度。总之,虽然EM III-IV期与更多的慢性病变相关,而I-II期与更多的活动性免疫疾病相关,但组织学慢性评分似乎更能预测长期预后。
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来源期刊
Ultrastructural Pathology
Ultrastructural Pathology 医学-病理学
CiteScore
2.00
自引率
10.00%
发文量
40
审稿时长
6-12 weeks
期刊介绍: Ultrastructural Pathology is the official journal of the Society for Ultrastructural Pathology. Published bimonthly, we are the only journal to be devoted entirely to diagnostic ultrastructural pathology. Ultrastructural Pathology is the ideal journal to publish high-quality research on the following topics: Advances in the uses of electron microscopic and immunohistochemical techniques Correlations of ultrastructural data with light microscopy, histochemistry, immunohistochemistry, biochemistry, cell and tissue culturing, and electron probe analysis Important new, investigative, clinical, and diagnostic EM methods.
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