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Fractional excretion of IgG in idiopathic membranous nephropathy with nephrotic syndrome: a predictive marker of risk and drug responsiveness.

Bazzi, Claudio; Rizza, Virginia; Casellato, Daniela; Tofik, Rafid LU ; Berg, Anna-Lena LU ; Gallieni, Maurizio; D'Amico, Giuseppe and Bakoush, Omran LU (2014) In BMC Nephrology 15.
Abstract
BACKGROUND:

Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still controversial. There is currently little known about the clinical use of renal biomarkers which may explain contradictory results obtained from clinical trials. In order to assess whether IgG-uria can predict the outcome in membranous nephropathy, we examined the value of baseline EF-IgG in predicting remission and progression of nephrotic syndrome.



METHODS:

In a prospective cohort of 84 (34 female) idiopathic membranous nephropathy patients with nephrotic syndrome we validated the ability of the clinically available urine biomarker, IgG, to predict the risk of kidney disease progression and the beneficial effect... (More)
BACKGROUND:

Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still controversial. There is currently little known about the clinical use of renal biomarkers which may explain contradictory results obtained from clinical trials. In order to assess whether IgG-uria can predict the outcome in membranous nephropathy, we examined the value of baseline EF-IgG in predicting remission and progression of nephrotic syndrome.



METHODS:

In a prospective cohort of 84 (34 female) idiopathic membranous nephropathy patients with nephrotic syndrome we validated the ability of the clinically available urine biomarker, IgG, to predict the risk of kidney disease progression and the beneficial effect of immunosuppression with steroids and cyclophosphamide. The fractional excretion of IgG (FE-IgG) and α1-microglobulin (FE-α1m), urine albumin/creatinine ratio, and eGFR were measured at the time of kidney biopsy. Primary outcome was progression to end stage kidney failure or kidney function (eGFR) decline ≥ 50% of baseline. Patients were followed up for 7.2 ± 4.1 years (range 1-16.8).



RESULTS:

High FE-IgG (≥ 0.02) predicted an increased risk of kidney failure (Hazard Ratio, (HR) 8.2, 95%CI 1.0-66.3, p=0.048) and lower chance of remission (HR 0.18, 95%CI 0.09-0.38, p<0.001). The ten-year cumulative risk of kidney failure was 51.7% for patients with high FE-IgG compared to only 6.2% for patients with low FE-IgG. During the study, only 24% of patients with high FE-IgG entered remission compared to 90% of patients with low FE-IgG. Combined treatment with steroids and cyclophosphamide decreased the progression rate (-40%) and increased the remission rate (+36%) only in patients with high FE-IgG.



CONCLUSION:

In idiopathic membranous nephropathy patients with nephrotic syndrome, FE-IgG could be useful for predicting kidney disease progression, remission, and response to treatment. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Albuminuria, Idiopathic membranous glomerulonephritis, Immunoglobulin G, Steroids, Cyclophosphamide, ESRD, Nephrotic syndrome, Proteinuria, Treatment outcome
in
BMC Nephrology
volume
15
publisher
BioMed Central
external identifiers
  • wos:000335795500001
  • pmid:24886340
  • scopus:84900875533
ISSN
1471-2369
DOI
10.1186/1471-2369-15-74
language
English
LU publication?
yes
id
fb99fc87-a44d-4509-887d-b5faa90ee65f (old id 4529492)
date added to LUP
2014-07-04 12:19:49
date last changed
2017-10-01 04:08:27
@article{fb99fc87-a44d-4509-887d-b5faa90ee65f,
  abstract     = {BACKGROUND:<br/><br>
Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still controversial. There is currently little known about the clinical use of renal biomarkers which may explain contradictory results obtained from clinical trials. In order to assess whether IgG-uria can predict the outcome in membranous nephropathy, we examined the value of baseline EF-IgG in predicting remission and progression of nephrotic syndrome.<br/><br>
<br/><br>
METHODS:<br/><br>
In a prospective cohort of 84 (34 female) idiopathic membranous nephropathy patients with nephrotic syndrome we validated the ability of the clinically available urine biomarker, IgG, to predict the risk of kidney disease progression and the beneficial effect of immunosuppression with steroids and cyclophosphamide. The fractional excretion of IgG (FE-IgG) and α1-microglobulin (FE-α1m), urine albumin/creatinine ratio, and eGFR were measured at the time of kidney biopsy. Primary outcome was progression to end stage kidney failure or kidney function (eGFR) decline ≥ 50% of baseline. Patients were followed up for 7.2 ± 4.1 years (range 1-16.8).<br/><br>
<br/><br>
RESULTS:<br/><br>
High FE-IgG (≥ 0.02) predicted an increased risk of kidney failure (Hazard Ratio, (HR) 8.2, 95%CI 1.0-66.3, p=0.048) and lower chance of remission (HR 0.18, 95%CI 0.09-0.38, p&lt;0.001). The ten-year cumulative risk of kidney failure was 51.7% for patients with high FE-IgG compared to only 6.2% for patients with low FE-IgG. During the study, only 24% of patients with high FE-IgG entered remission compared to 90% of patients with low FE-IgG. Combined treatment with steroids and cyclophosphamide decreased the progression rate (-40%) and increased the remission rate (+36%) only in patients with high FE-IgG.<br/><br>
<br/><br>
CONCLUSION:<br/><br>
In idiopathic membranous nephropathy patients with nephrotic syndrome, FE-IgG could be useful for predicting kidney disease progression, remission, and response to treatment.},
  articleno    = {74},
  author       = {Bazzi, Claudio and Rizza, Virginia and Casellato, Daniela and Tofik, Rafid and Berg, Anna-Lena and Gallieni, Maurizio and D'Amico, Giuseppe and Bakoush, Omran},
  issn         = {1471-2369},
  keyword      = {Albuminuria,Idiopathic membranous glomerulonephritis,Immunoglobulin G,Steroids,Cyclophosphamide,ESRD,Nephrotic syndrome,Proteinuria,Treatment outcome},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {BMC Nephrology},
  title        = {Fractional excretion of IgG in idiopathic membranous nephropathy with nephrotic syndrome: a predictive marker of risk and drug responsiveness.},
  url          = {http://dx.doi.org/10.1186/1471-2369-15-74},
  volume       = {15},
  year         = {2014},
}