Clinicopathological profile and prognosis of idiopathic membranous nephropathy in adults: a developing country perspective

Background: There is no study available from Pakistan on the longitudinal course of membranous nephropathy (MN). We aimed to analyse the clinicopathological profile, course, response to treatment and outcome of the disease in our setup. Methods: All consecutive adult patients (≥18 years) with MN on renal biopsy and on regular follow-up were included. Relevant data items were retrieved from case files and biopsy reports. The outcome variables included doubling of baseline serum creatinine or the development of end-stage renal disease (ESRD). Results: Of a total of 102 patients, 82 (80.4%) were males; mean age was 28.9±11.4 years. Peripheral oedema was present in 86 (84.3%), nephrotic-range proteinuria in 80 (78.4%), microscopic haematuria in 25 (24.5%), hypertension in 42 (41.2%), and renal dysfunction in 13 (12.7%) patients at the time of presentation. The mean follow-up period was 3±2 years. Overall, 22 (21.5%) subjects went into remission and a similar number experienced doubling of serum creatinine. Both conservative and immunosuppressive treatment groups had similar duration of follow-up. The proportion of patients with remission and doubling of serum creatinine was similar between the two groups (p=0.70 and p=0.91 respectively), while the proportion of patients progressing to ESRD was significantly higher in the group treated conservatively (p=0.03). Baseline proteinuria and serum creatinine were predictive of remission (p=0.04 and p=0.05 respectively). Conclusions: In conclusion, untreated MN has a higher risk of progression to ESRD. Baseline proteinuria and serum creatinine predict response to treatment. Randomised controlled trials are needed to confirm the effects of immunosuppressive treatment