Clinical profile and outcome of primary membranous nephropathy: A tertiary care center experience from North India

Table 1 Risk stratification of patients with membranous nephropathy

Very high risk	High risk	Moderate risk	Low risk
Presence of any 2 of the following is considered to be at very high risk of disease progression: Serum creatinine > 1.5 mg/dL, considered to be due to MN; progressive decline in kidney function, > 25% decline in eGFR from the baseline over the prior 2 years; severe, disabling, or life-threatening nephrotic syndrome is defined by serum albumin < 2.5 g/dL and a refractory edema, or a thromboembolic event	Presence of ≥ 2 of the following is considered to be high risk: Decrease in eGFR > 25% not explained by other causes at any time during the observation period; proteinuria > 8 g/day at the end of the observation period or persistent nephrotic syndrome; patient is anti-PLA2R antibody positive, serial anti-PLA2R antibody titres are high (> 150 RU/mL by ELISA) and not decreasing or are increasing to > 150 RU/mL	Presence of ≥ 2 of the following: Normal or stable eGFR (< 25% decrease) over a 3-month to 6-month period; persistent proteinuria between 4 g/day and 8 g/day at the end of the observation period; patient is anti-PLA2R antibody positive, serial anti-PLA2R antibody titres are < 150 RU/mL by ELISA and stable or increasing by < 25% over 6-month period	Normal or stable eGFR (< 25% decrease) over a 3-month to 6-month period; proteinuria < 4 g/day at the end of the observation period; patient is anti-PLA2R antibody positive, serial anti-PLA2R antibody titres are persistently low < 50 RU/mL by ELISA or are decreasing by ≥ 25% at 3-month to 6-month period

eGFR: Estimated glomerular filtration rate; PLA2R: Phospholipase A2 receptor; ELISA: Enzyme-linked immunosorbent assay.

Table 2 Baseline characteristics of the study population

Parameter	Mean	SD
BMI (kg/m2)	24.8	3.4
Systolic blood pressure (mmHg)	126	12.7
Diastolic blood pressure (mmHg)	75.7	8.7
Cholesterol (mg/dL)	253.1	84.4
Triglycerides (mg/dL)	297	89.5
LDL (mg/dL)	148	54.1
HDL (mg/dL)	52.3	14.2
Hemoglobin (g/dL)	12.3	1.7
Total serum protein (g/dL)	6.1	0.85
Proteinuria (g/dL)	5.8	3.2
Serum albumin (g/dL)	2.5	0.39
Urea (mg/dL)	30.8	22.4
Creatinine (mg/dL)	0.8	0.3
eGFR (ml/minute/1.73 m2)	99.83	26.6
Anti-PLA2R titre (RU/mL)	81.6	148.5

BMI: Body mass index; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; eGFR: Estimated glomerular filtration rate; PLA2R: Phospholipase A2 receptor.

Table 3 Clinical features of the study population

Clinical features	n (%)
Nephrotic syndrome	34 (73.9)
Edema	46 (100)
Foamy urine	38 (82.6)
Microscopic hematuria	12 (26.1)

Table 4 Comorbidities in the study population

Comorbidity	n (%)
Hypertension	17 (37)
Hypothyroidism	6 (13)
Obesity	6 (13)
Diabetes mellitus	3 (6.5)

Table 5 Comparison of remission with baseline risk category after supportive care [Fisher’s exact test, n (%)]

Risk	Remission	No remission	Total	P value
Low or moderate	5 (38.5)	8 (61.5)	13 (100)	0.129
High	4 (15.4)	22 (84.6)	26 (100)
Total	9 (23.08)	30 (76.92)	39 (100)

Table 6 Comparison of baseline parameters between modified Ponticelli regimen vs other immunosuppression, mean ± SD

Parameter	Modified Ponticelli regimen	Others	P value
Proteinuria (g/day)	8.77 ± 3.12	7.22 ± 2.69	0.109
Serum albumin (g/dL)	2.07 ± 0.52	2.16 ± 0.54	0.6
Serum creatinine (mg/dL)	0.99 ± 0.44	0.74 ± 0.14	0.02

Table 7 Comparison of various parameters at baseline and at 12 months, mean ± SD

Therapy	Parameter	Baseline	At 12 months	P value
Modified Ponticelli regimen	Proteinuria (g/day)	8.77 ± 3.12	1.75 ± 2.02	< 0.0001
	Serum albumin (g/dL)	2.07 ± 0.52	3.71 ± 0.57	< 0.0001
	Serum creatinine (mg/dL)	0.99 ± 0.43	1.02 ± 0.52	0.845
Other	Proteinuria (g/day)	7.22 ± 2.69	0.89 ± 1.24	< 0.0001
	Serum albumin (g/dL)	2.15 ± 0.55	3.94 ± 0.48	< 0.0001
	Serum creatinine (mg/dL)	0.74 ± 0.14	0.78 ± 0.22	0.492