Lupus-like membranous nephropathy: Is it lupus or not?

Ramin Sam, Amit Joshi, Sam James, Kuang-Yu Jen, Firouz Amani, Peter Hart, Melvin M. Schwartz

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Membranous glomerulonephritis is typically classified as idiopathic or secondary to systemic lupus erythematosus (SLE), hepatitis B, drugs, toxins, other infections, or malignancy. Not infrequently in some patients without a definite diagnosis of SLE, pathologic features of secondary membranous nephropathy are seen e.g., mesangial and/or subendothelial deposits, tubuloreticular inclusions, and full house immunofluorescence. In these patients, there is uncertainty about the etiology, response to therapy, and prognosis of membranous GN. Methods: We retrospectively reviewed the charts of 98 patients with membranous GN at San Francisco General Hospital and John Stroger Hospital of Cook County over a 10-year period. Data were collected and analyzed using SPSS.18. Results: Thirty-nine (40 %) had idiopathic membranous GN (Group 1), thirty-six (37 %) had lupus membranous GN (Group 2) and twenty-three (23 %) had some pathological features of secondary membranous GN, but no definite etiology of membranous GN (Group 3). At baseline (at time of renal biopsy) and after mean follow-up of 3.5 years, the average serum creatinine (in mg/dL) in Group 1 was (1.6 ± 1.0 versus 1.6 ± 1.7), Group 2 was (1.8 ± 2.5 versus 1.2 ± 0.9) and Group 3 was (1.1 ± 0.4 versus 1.27 ± 0.83), respectively. For the same time points, the average urine protein to creatinine ratio (g/g) in Group 1 was (9.8 ± 7.1 versus 5.7 ± 6.7), Group 2 was (4.2 ± 3.9 versus 1.7 ± 2.2), and Group 3 was (7.4 ± 5.7 versus 3.1 ± 3.8). In addition, during the follow-up period, eleven of 39 (28 %) in Group 1, two of 36 (6 %) in Group 2, and three of 23 (13 %) in Group 3 progressed to end-stage renal disease and were started on dialysis. Conclusions: It appears that patients with lupus membranous GN have better renal prognosis than patients with idiopathic membranous GN. The renal prognosis for patients with pathological features of lupus membranous but no diagnosis of systemic lupus (lupus-like membranous GN) falls in between. Further studies are needed to determine if Group 3 patients can (a) definitively be classified as true idiopathic membranous GN or lupus membranous GN or (b) they have a separate disease from either M-type phospholipase A2 receptor membranous nephropathy or systemic lupus-induced membranous nephropathy.

Original languageEnglish (US)
Pages (from-to)395-402
Number of pages8
JournalClinical and Experimental Nephrology
Volume19
Issue number3
DOIs
StatePublished - Jun 17 2015
Externally publishedYes

Keywords

  • Idiopathic membranous
  • Membranous GN
  • Pathological features of lupus membranous
  • Systemic lupus

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

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    Sam, R., Joshi, A., James, S., Jen, K-Y., Amani, F., Hart, P., & Schwartz, M. M. (2015). Lupus-like membranous nephropathy: Is it lupus or not? Clinical and Experimental Nephrology, 19(3), 395-402. https://doi.org/10.1007/s10157-014-1002-1