Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome

Tianxin Chen, Ying Zhou, Xinxin Chen, Bo Chen, Jingye Pan, Tianxin Chen, Ying Zhou, Xinxin Chen, Bo Chen, Jingye Pan

Abstract

Background and objectives: The impact of acute kidney injury (AKI) on the progression of renal function in idiopathic membranous nephropathy (iMN) with nephrotic syndrome (NS) patients have not yet been reported, we sought to investigate the incidence, clinical features and prognosis of AKI in iMN with NS patients and determine clinical predictors for progression from AKI to advanced chronic kidney disease (CKD) stage.

Methods: We analyzed clinical and pathological data of iMN with NS patients retrospectively collected from Jan 2012 to Dec 2018. The primary renal endpoint was defined as persistent eGFR <45ml/min per 1.73 m2 more than 3 months. Comparisons of survival without primary renal endpoint were performed by Kaplan-Meier curves and log-rank test. Univariate and multivariate Cox proportional hazard models were constructed to determine independent variables associated with primary renal endpoint .

Results: 434 iMN with NS patients were enrolled. The incidence of AKI 1 stage, AKI 2 stage and AKI 3 stage was 23.1, 4.8 and 0.7% respectively. 66 (53.2%) patients with AKI had complete renal function recovery and 42 (33.9%) patients with AKI reached primary renal endpoint. Survival without primary renal endpoint was worse in AKI patients than No AKI patients (67.1 ± 5.3 and 43.7 ± 7.3% vs 99.5 ± 0.5 and 92.5 ± 4.2% at 2 and 4 years,p < 0.001). AKI was independently associated with primary renal endpoint, with an adjusted hazard ratio(HR) of 25.1 (95%CI 7.7-82.1, p < 0.001).

Conclusions: AKI was usually mild and overlooked in iMN patients with NS, but it had a strong association with poor clinical outcomes and was an independent risk factor for CKD progression.

Keywords: Membranous nephropathy; acute kidney injury; chronic kidney disease; end-stage renal disease; nephrotic syndrome.

Conflict of interest statement

All authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Description of patients selection. MN: membranous nephropathy; iMN: idiopathic membranous nephropathy; NS: nephrotic syndrome; DN: Diabetic nephropathy; IgAN: IgA nephropathy; FSGS: focal segmental glomerular sclerosis;FPGN: focal proliferative glomerulonephritis; FNG: Focal necrosis glomerulonephritis; AIN,acute interstitial nephritis; AKI, acute kidney injury; LN: lupus nephritis; SS: Sjogren's syndrome; HBV-GN: hepatitis B virus associated glomerular nephritis.
Figure 2.
Figure 2.
An illustration of the change of Scr in patients without renal function progression. The numbers of patients from whom readings were taken at each point are presented; variation in numbers was due to deterioration of renal function in some patients at the point.
Figure 3.
Figure 3.
Survival rate without primary renal endpoint. Survival rate without primary renal endpoint (AKI vs No AKI) was 67.1 ± 5.3 and 43.7 ± 7.3% vs 99.5 ± 0.5 and 92.5 ± 4.2% at 2 and 4 years (p < 0.001); the median time to survival without primary renal endpoint was 48.0 ± 10.0 vs 74.0 ± 3.0 months.
Figure 4.
Figure 4.
comparison of survival rate without primary renal endpoint between two groups based on remission status. (A) survival rate without primary renal endpoint (AKI vs No AKI ) was 44.9 ± 8.2% vs 98.4 ± 1.6% (p < 0.001) at 2 years in the cohort without remission; (B) survival rate without primary renal endpoint (AKI vs No AKI) was 84.9 ± 8.7% vs 100% (p = 0.001) at 2 years in the cohort with partial remission; (C) survival rate without primary renal endpoint (AKI vs No AKI) was 95.0 ± 4.9% vs 100% (p < 0.001) at 2 years in the cohort with complete remission.

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