The thickness of glomerular basement membrane predicts complete remission in primary membranous nephropathy

Suyan Duan; Lianqin Sun; Chengning Zhang; Ming Zeng; Bin Sun; Yanggang Yuan; Huijuan Mao; Changying Xing; Bo Zhang

doi:10.1080/0886022X.2023.2179335

The thickness of glomerular basement membrane predicts complete remission in primary membranous nephropathy

Ren Fail. 2023 Dec;45(1):2179335. doi: 10.1080/0886022X.2023.2179335.

Authors

Suyan Duan¹, Lianqin Sun¹, Chengning Zhang¹, Ming Zeng¹, Bin Sun¹, Yanggang Yuan¹, Huijuan Mao¹, Changying Xing¹, Bo Zhang^{1

2}

Affiliations

¹ Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China.
² Department of Nephrology, Pukou Branch of JiangSu Province Hospital (Nanjing Pukou Central Hospital), Nanjing, P.R. China.

Abstract

Objective: Glomerular basement membrane (GBM) thickening is a typical and essential histopathological characteristic for the diagnosis of primary membranous nephropathy (PMN). The present study aimed to explore the relationship between GBM thickness and treatment response in PMN patients.Methods: A total of 128 patients with nephrotic syndrome concurrent with PMN were studied. The highest GBM thickness was measured from at least five glomerular capillary loops using an electron microscope, and the mean value was obtained. Patients were categorized into three groups according to the tertiles of GBM thickness as follows: Group 1 (GBM thickness ≤ 1100 nm, n = 48), Group 2 (1100 nm < GBM thickness ≤ 1300 nm, n = 40), Group 3 (GBM thickness >1300 nm, n = 40). Clinicopathological features and treatment response were compared among the three groups. The associations of GBM thickness with complete remission (CR) were assessed by Cox proportional hazard analyses and a cubic spline curve.Results: During a median follow-up period of 25.80 months, 69 (53.9%) patients achieved CR. Kaplan-Meier analysis showed that the non-CR probability was significantly higher in the highest tertile of GBM thickness (p˂0.001). Univariate Cox proportional hazard analysis indicated that GBM thickness was associated with CR (HR per SD 0.617, 95% CI [0.471-0.809], p˂0.001). After adjusting for age, duration of PMN, estimated glomerular filtration rate (eGFR), urinary protein excretion, grade of C3 deposition, and titer of serum anti-phospholipase A2 receptor (PLA2R) antibody, GBM thickness remained an independent predictor of CR (HR per SD 0.580, 95% CI [0.436-0.772], p˂0.001). Further multivariable-adjusted restricted cubic spline analysis confirmed a significant reverse linear association between GBM thickness and CR (p for nonlinear = 0.1261).Conclusions: GBM thickness is an independent risk factor of CR. PMN patients with an increased level of GBM thickening at diagnosis have a lower probability of achieving CR.

Keywords: GBM thickness; complete remission; primary membranous nephropathy; proteinuria.

MeSH terms

Glomerular Basement Membrane
Glomerulonephritis, Membranous* / drug therapy
Humans
Kaplan-Meier Estimate
Nephrotic Syndrome*
Receptors, Phospholipase A2

Substances

Receptors, Phospholipase A2

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (82100767), the Natural Science Foundation of Jiangsu Province (BK20191075), "PRO•Run" Fund of the Nephrology Group of CEBM, Project of clinical capability improvement of the First Affiliated Hospital of Nanjing Medical University(JSPH-MC-2021-14), Project of Beijng Bethune Charitable Foundation(PAYJ-058), and the Priority Academic Program Development (PAPD) of Jiangsu Higher Education Institution.