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Article ; Online: Cutaneous vascular structure and perfusion in patients with chronic plaque psoriasis.

Luengas-Martinez, Andrea / Kamaly-Asl, Anna / Chaudhry, Iskander H / Brenchley, Paul E C / Young, Helen S

2023 Volume 48, Issue 3, Page(s) 181–187

Abstract: Background: Vascular dysfunction is a significant contributor to the pathophysiology of psoriasis. Some individuals have variation within the gene for vascular endothelial growth factor-A (VEGF-A), which confers an increased risk of developing psoriasis ...

Abstract	Background: Vascular dysfunction is a significant contributor to the pathophysiology of psoriasis. Some individuals have variation within the gene for vascular endothelial growth factor-A (VEGF-A), which confers an increased risk of developing psoriasis and having a severe disease phenotype, and may determine responsiveness to treatment. Aim: To determine whether patients with psoriasis have alterations in cutaneous microvascular anatomy and physiology due to expression of VEGF and whether laser Doppler imaging has utility in the assessment of this. Methods: Twelve adult volunteers with Type 1 chronic plaque psoriasis underwent laser Doppler imaging of plaque and uninvolved skin. Skin biopsies were taken from the areas imaged for immunohistochemistry, including blood and lymphatic vessel markers, and VEGF-A isotype analysis (VEGF-A121, VEGF-A165 and VEGF-D). Venous blood was collected for DNA extraction, VEGF-A genotyping and peripheral blood mononuclear cell culture. Results: Mean blood vessel area (P < 0·01), number of blood vessels (P < 0·001), number of lymphatic vessels (P < 0·001) and blood flow (P < 0·001) was significantly increased in psoriasis plaques, as was expression of VEGF-A121 (P < 0·01), VEGF-A165 (P < 0·04) and VEGF-D (P < 0·01). Blood flow within psoriasis plaques was independent of their increased vascularity (P < 0·01) and may be associated with baseline productivity of VEGF. The number of blood vessels within uninvolved skin in patients with psoriasis was associated with the VEGF-A (rs833061) genotype (P = 0·01), in a relationship suggesting an allele dosing effect. Conclusion: Noninvasive imaging of blood flow may help determine the cutaneous vascular signature for individual patients. This may be a useful prognostic indicator of psoriasis susceptibility and severity, and thus support selection of treatments.
MeSH term(s)	Humans ; Vascular Endothelial Growth Factor A/metabolism ; Vascular Endothelial Growth Factor D/metabolism ; Leukocytes, Mononuclear/metabolism ; Skin/pathology ; Psoriasis/pathology ; Perfusion
Chemical Substances	Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor D
Language	English
Publishing date	2023-02-10
Publishing country	England
Document type	Journal Article
ZDB-ID	195504-4
ISSN	1365-2230 ; 0307-6938
ISSN (online)	1365-2230
ISSN	0307-6938
DOI	10.1093/ced/llac047
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Zs.A 1278: Show issues

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Article ; Online: Anti-phospholipase A2 Receptor Antibody and Immunosuppression in Membranous Nephropathy: More Evidence for Pathogenicity of Anti-phospholipase A2 Receptor Autoantibodies.

Brenchley, Paul E C

Journal of the American Society of Nephrology : JASN

2015 Volume 26, Issue 10, Page(s) 2308–2311

MeSH term(s)	Autoantibodies/blood ; Female ; Glomerulonephritis, Membranous/blood ; Glomerulonephritis, Membranous/drug therapy ; Humans ; Immunologic Factors/therapeutic use ; Male ; Receptors, Phospholipase A2/immunology ; Rituximab/therapeutic use
Chemical Substances	Autoantibodies ; Immunologic Factors ; Receptors, Phospholipase A2 ; Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2015-03-24
Publishing country	United States
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1085942-1
ISSN	1533-3450 ; 1046-6673
ISSN (online)	1533-3450
ISSN	1046-6673
DOI	10.1681/ASN.2015020181
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Zs.A 3344: Show issues

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Article ; Online: Membranous nephropathy: integrating basic science into improved clinical management.

Cattran, Daniel C / Brenchley, Paul E

Kidney international

2017 Volume 91, Issue 3, Page(s) 566–574

Abstract: Idiopathic membranous nephropathy (INM) remains a common cause of the nephrotic syndrome in adults. The autoimmune nature of IMN was clearly delineated in 2009 with the identification of the glomerular-deposited IgG to be a podocyte receptor, ... ...

Abstract	Idiopathic membranous nephropathy (INM) remains a common cause of the nephrotic syndrome in adults. The autoimmune nature of IMN was clearly delineated in 2009 with the identification of the glomerular-deposited IgG to be a podocyte receptor, phospholipase A2 receptor (PLA2R) in 70% to 75% of cases. This anti-PLA2R autoantibody, predominantly the IgG4 subclass, has been quantitated in serum using an enzyme-linked immunosorbent assay and has been used to aid diagnosis and monitor response to immunosuppressive therapy. In 2014, a second autoantigen, thrombospondin type 1 domain-containing 7A (THSD7A), was identified. Immunostaining of biopsy specimens has further detected either PLA2R or THSD7A antigen in the deposited immune complexes in 5% to 10% of cases autoantibody seronegative at the time of biopsy. Therefore, the term IMN should now be superseded by the term primary or autoimmune MN (AMN) (anti-PLA2R or anti-THSD7A positive) classifying ∼80% to 90% of cases previously designated IMN. Cases of secondary MN associated with other diseases show much lower association with these autoantibodies, but their true incidence in secondary cases still needs to be defined. How knowledge of the autoimmune mechanism and the sequential measurement of these autoantibodies is likely to change the clinical management and trajectory of AMN by more precisely defining its diagnosis, prognosis, and treatment is discussed. Their application early in the disease course to new and old therapies will provide additional precision to AMN management. We also review innovative therapeutic approaches on the horizon that are expected to lead to our ultimate goal of improved patient care in A(I)MN.
MeSH term(s)	Animals ; Autoantibodies/blood ; Autoimmunity/drug effects ; Glomerulonephritis, Membranous/blood ; Glomerulonephritis, Membranous/diagnosis ; Glomerulonephritis, Membranous/drug therapy ; Glomerulonephritis, Membranous/immunology ; Humans ; Immunoglobulin G/blood ; Immunosuppressive Agents/therapeutic use ; Kidney Glomerulus/drug effects ; Kidney Glomerulus/immunology ; Kidney Glomerulus/pathology ; Nephrotic Syndrome/blood ; Nephrotic Syndrome/diagnosis ; Nephrotic Syndrome/drug therapy ; Nephrotic Syndrome/immunology ; Receptors, Phospholipase A2/immunology ; Thrombospondins/immunology
Chemical Substances	Autoantibodies ; Immunoglobulin G ; Immunosuppressive Agents ; Receptors, Phospholipase A2 ; THSD7A protein, human ; Thrombospondins
Language	English
Publishing date	2017-01-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1016/j.kint.2016.09.048
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Zs.A 797: Show issues

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Article ; Online: Structure of PLA2R reveals presentation of the dominant membranous nephropathy epitope and an immunogenic patch.

Fresquet, Maryline / Lockhart-Cairns, Michael P / Rhoden, Samuel J / Jowitt, Thomas A / Briggs, David C / Baldock, Clair / Brenchley, Paul E / Lennon, Rachel

Proceedings of the National Academy of Sciences of the United States of America

2022 Volume 119, Issue 29, Page(s) e2202209119

Abstract: Membranous nephropathy is an autoimmune kidney disease caused by autoantibodies targeting antigens present on glomerular podocytes, instigating a cascade leading to glomerular injury. The most prevalent circulating autoantibodies in membranous ... ...

Abstract	Membranous nephropathy is an autoimmune kidney disease caused by autoantibodies targeting antigens present on glomerular podocytes, instigating a cascade leading to glomerular injury. The most prevalent circulating autoantibodies in membranous nephropathy are against phospholipase A2 receptor (PLA2R), a cell surface receptor. The dominant epitope in PLA2R is located within the cysteine-rich domain, yet high-resolution structure-based mapping is lacking. In this study, we define the key nonredundant amino acids in the dominant epitope of PLA2R involved in autoantibody binding. We further describe two essential regions within the dominant epitope and spacer requirements for a synthetic peptide of the epitope for drug discovery. In addition, using cryo-electron microscopy, we have determined the high-resolution structure of PLA2R to 3.4 Å resolution, which shows that the dominant epitope and key residues within the cysteine-rich domain are accessible at the cell surface. In addition, the structure of PLA2R not only suggests a different orientation of domains but also implicates a unique immunogenic signature in PLA2R responsible for inducing autoantibody formation and recognition.
MeSH term(s)	Antigen Presentation ; Autoantibodies/chemistry ; Binding Sites ; Cryoelectron Microscopy ; Cysteine/chemistry ; Glomerulonephritis, Membranous/immunology ; Humans ; Immunodominant Epitopes/chemistry ; Immunodominant Epitopes/immunology ; Protein Domains ; Receptors, Phospholipase A2/chemistry ; Receptors, Phospholipase A2/immunology
Chemical Substances	Autoantibodies ; Immunodominant Epitopes ; Receptors, Phospholipase A2 ; Cysteine (K848JZ4886)
Language	English
Publishing date	2022-07-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	209104-5
ISSN	1091-6490 ; 0027-8424
ISSN (online)	1091-6490
ISSN	0027-8424
DOI	10.1073/pnas.2202209119
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Zs.A 1148: Show issues

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Article ; Online: Anti-PLA2R Antibody Levels and Clinical Risk Factors for Treatment Nonresponse in Membranous Nephropathy.

Barbour, Sean J / Fervenza, Fernando C / Induruwage, Dilshani / Brenchley, Paul E / Rovin, Brad / Hladunewich, Michelle A / Reich, Heather N / Lafayette, Richard / Aslam, Nabeel / Appel, Gerald B / Zand, Ladan / Kiryluk, Krzysztof / Liu, Lili / Cattran, Daniel C

Clinical journal of the American Society of Nephrology : CJASN

2023 Volume 18, Issue 10, Page(s) 1283–1293

Abstract: ... performance was evaluated using C-statistics and model fit (Akaike information criterion [AIC], R 2 ... at 3 months had better model fit (AIC 70.9 versus 96.4, R 2 51.8% versus 30.1%) and higher C-statistic ... with the model at 3 months (AIC 68.6, R 2 53.0%, C-statistic 0.94, P = 0.67).: Conclusions: In patients ...

Abstract	Background: The 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend following anti-phospholipase A2 receptor (PLA2R) antibody levels as a marker of treatment response in membranous nephropathy; however, the optimal timing to evaluate antibody levels and how to combine them with other clinical variables are currently unknown. Methods: We used a cohort of 85 patients from the Membranous Nephropathy Trial Of Rituximab (MENTOR) with anti-PLA2R antibodies ≥14 RU/ml to identify risk factors for not experiencing proteinuria remission after 12 months of treatment with cyclosporine or rituximab. Three landmark times were considered: at baseline and after 3 and 6 months of treatment. Logistic regression model performance was evaluated using C-statistics and model fit (Akaike information criterion [AIC], R 2 ). Results: The model at baseline that best predicted no remission included anti-PLA2R antibodies >323 RU/ml and creatinine clearance; the best model after 3 months included the change from baseline in both antibody and albumin levels; and the best model after 6 months included antibody levels >14 RU/ml, creatinine clearance, and the change from baseline in albumin. Compared with the model at baseline, the model at 3 months had better model fit (AIC 70.9 versus 96.4, R 2 51.8% versus 30.1%) and higher C-statistic (0.93 versus 0.83, P = 0.008). The model at 6 months had no difference in performance compared with the model at 3 months (AIC 68.6, R 2 53.0%, C-statistic 0.94, P = 0.67). Conclusions: In patients with membranous nephropathy treated with cyclosporine or rituximab in the MENTOR trial, we found that the optimal method to evaluate risk factors for the probability of treatment response was to use anti-PLA2R antibody levels combined with albumin levels after 3 months of treatment, which was significantly better than using antibody levels alone or risk factor evaluation at baseline, with no added benefit of waiting until 6 months of treatment. Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_10_09_CJN0000000000000237.mp3.
MeSH term(s)	Humans ; Glomerulonephritis, Membranous/drug therapy ; Rituximab/therapeutic use ; Receptors, Phospholipase A2 ; Creatinine ; Cyclosporine/therapeutic use ; Risk Factors ; Albumins ; Autoantibodies
Chemical Substances	Rituximab (4F4X42SYQ6) ; Receptors, Phospholipase A2 ; Creatinine (AYI8EX34EU) ; Cyclosporine (83HN0GTJ6D) ; Albumins ; Autoantibodies
Language	English
Publishing date	2023-07-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.0000000000000237
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Zs.A 6584: Show issues

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Article ; Online: A Genetic Risk Score Distinguishes Different Types of Autoantibody-Mediated Membranous Nephropathy.

Gupta, Sanjana / Downie, Mallory Lorraine / Cheshire, Chris / Dufek-Kamperis, Stephanie / Levine, Adam Paul / Brenchley, Paul / Hoxha, Elion / Stahl, Rolf / Ashman, Neil / Pepper, Ruth Jennifer / Mason, Sean / Norman, Jill / Bockenhauer, Detlef / Stanescu, Horia Constantin / Kleta, Robert / Gale, Daniel Philip

Glomerular diseases

2023 Volume 3, Issue 1, Page(s) 116–125

Abstract: Introduction: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults and is characterized by detectable autoantibodies against glomerular antigens, most commonly phospholipase A2 receptor 1 (PLA2R1) and thrombospondin type-1 ... ...

Abstract	Introduction: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults and is characterized by detectable autoantibodies against glomerular antigens, most commonly phospholipase A2 receptor 1 (PLA2R1) and thrombospondin type-1 domain containing 7A (THSD7A). In Europeans, genetic variation in at least five loci, Methods: 1,409 MN individuals were genotyped genome-wide with a dense SNV array. The genetic risk score (GRS) was calculated utilizing the previously identified European MN loci, and results were compared with 4,929 healthy controls and 422 individuals with steroid-sensitive nephrotic syndrome. Results: GRS was calculated in the 759 MN individuals in whom antibody status was known. The GRS for MN was elevated in the anti-PLA2R1 antibody-positive ( Conclusion: We demonstrate that the genetic risk factors for PLA2R1- and THSD7A-antibody-associated MN are different. A higher GRS is associated with younger age of onset of disease. Further, a proportion of antibody-negative MN cases have an elevated GRS similar to PLA2R1-positive disease. This suggests that in some individuals with negative serology the disease is driven by autoimmunity against PLA2R1.
Language	English
Publishing date	2023-03-13
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-3633
ISSN (online)	2673-3633
DOI	10.1159/000529959
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Article ; Online: Identification of a Locus on the X Chromosome Linked to Familial Membranous Nephropathy.

Downie, Mallory L / Gupta, Sanjana / Tekman, Mehmet C / Cheshire, Chris / Arora, Steven / Licht, Christoph / Robinson, Lisa A / Munoz, Marina / Aris, Alvaro Madrid / Al Attrach, Ibrahim / Brenchley, Paul E / Gale, Daniel P / Stanescu, Horia / Bockenhauer, Detlef / Kleta, Robert

Kidney international reports

2021 Volume 6, Issue 6, Page(s) 1669–1676

Abstract: Introduction: Membranous nephropathy (MN) is the most common cause of nephrotic syndrome (NS) in adults and is a leading cause of end-stage renal disease due to glomerulonephritis. Primary MN has a strong male predominance, accounting for approximately ... ...

Abstract	Introduction: Membranous nephropathy (MN) is the most common cause of nephrotic syndrome (NS) in adults and is a leading cause of end-stage renal disease due to glomerulonephritis. Primary MN has a strong male predominance, accounting for approximately 65% of cases; yet, currently associated genetic loci are all located on autosomes. Previous reports of familial MN have suggested the existence of a potential X-linked susceptibility locus. Identification of such risk locus may provide clues to the etiology of MN. Methods: We identified 3 families with 8 members affected by primary MN. Genotyping was performed using single-nucleotide polymorphism microarrays, and serum was sent for anti-phospholipase A2 receptor (PLA2R) antibody testing. All affected members were male and connected through the maternal line, consistent with X-linked inheritance. Genome-wide multipoint parametric linkage analysis using a model of X-linked recessive inheritance was conducted, and genetic risk scores (GRSs) based on known MN-associated variants were determined. Results: Anti-PLA2R testing was negative in all affected family members. Linkage analysis revealed a significant logarithm of the odds score (3.260) on the short arm of the X chromosome at a locus of approximately 11 megabases (Mb). Haplotype reconstruction further uncovered a shared haplotype spanning 2 Mb present in all affected individuals from the 3 families. GRSs in familial MN were significantly lower than in anti-PLA2R-associated MN and were not different from controls. Conclusions: Our study identifies linkage of familial membranous nephropathy to chromosome Xp11.3-11.22. Family members affected with MN have a significantly lower GRS than individuals with anti-PLA2R-associated MN, suggesting that X-linked familial MN represents a separate etiologic entity.
Language	English
Publishing date	2021-03-03
Publishing country	United States
Document type	Journal Article
ISSN	2468-0249
ISSN (online)	2468-0249
DOI	10.1016/j.ekir.2021.02.025
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Article: Vascular permeability factors in steroid-sensitive nephrotic syndrome and focal segmental glomerulosclerosis.

Brenchley, Paul E C

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2003 Volume 18 Suppl 6, Page(s) vi21–5

Abstract: The concept that some forms of proteinuria may be induced by the action of circulating systemic permeability factors on the glomerular capillary wall is intriguing. First proposed in the 1970s in the context of steroid-sensitive nephrotic syndrome, the ... ...

Abstract	The concept that some forms of proteinuria may be induced by the action of circulating systemic permeability factors on the glomerular capillary wall is intriguing. First proposed in the 1970s in the context of steroid-sensitive nephrotic syndrome, the immune system was proposed as a source of such a vascular permeability factor (VPF). More recently, some forms of focal segmental glomerular sclerosis appear to be associated with another type of systemic factor. This paper reviews the evidence for such factors and compares the properties of a number of candidate VPFs.
MeSH term(s)	Glomerulosclerosis, Focal Segmental/etiology ; Humans ; Nephrotic Syndrome/drug therapy ; Nephrotic Syndrome/etiology ; Steroids/therapeutic use ; Vascular Endothelial Growth Factor A/physiology
Chemical Substances	Steroids ; Vascular Endothelial Growth Factor A
Language	English
Publishing date	2003-05-16
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfg1057
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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 329: Show issues

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Article ; Online: Pharmacology, efficacy and safety of oral phosphate binders.

Hutchison, Alastair J / Smith, Craig P / Brenchley, Paul E C

Nature reviews. Nephrology

2011 Volume 7, Issue 10, Page(s) 578–589

Abstract: The ideal serum level of phosphate in patients on dialysis, and the benefits of controlling levels of phosphate in serum remain unclear despite observational studies that associate phosphate levels with mortality. In the absence of robust data from ... ...

Abstract	The ideal serum level of phosphate in patients on dialysis, and the benefits of controlling levels of phosphate in serum remain unclear despite observational studies that associate phosphate levels with mortality. In the absence of robust data from trials, current guidelines are necessarily based on opinion. Oral phosphate binders are required by the majority of patients on dialysis, and all of these binders can control serum levels of phosphate to similar degrees. Patient preference and adherence to prescribed therapy is at least as important as the efficacy of the prescribed binder. Avoidance of calcium-containing binders has become accepted practice where the alternatives are affordable, but incontrovertible evidence in favor of this approach is lacking. Use of sevelamer and lanthanum avoids calcium loading, but at considerable financial cost and with no reliable patient outcome data to prove their value. Additional approaches to aid control of serum levels of phosphate include blockade of gastrointestinal phosphate absorption and possibly binding of salivary phosphate. Importantly, the role of phosphate control in determining patient outcomes must be quantified, which is likely to require a large randomized, controlled study of two levels of phosphate control. Without such a study we will continue to rely on observational data with all its uncertainties and potential to mislead.
MeSH term(s)	Acetates/therapeutic use ; Animals ; Calcium Compounds/therapeutic use ; Chelating Agents/pharmacology ; Chelating Agents/therapeutic use ; Fibroblast Growth Factors/blood ; Fibroblast Growth Factors/physiology ; Humans ; Hyperphosphatemia/drug therapy ; Hyperphosphatemia/physiopathology ; Hyperphosphatemia/prevention & control ; Intestinal Absorption/drug effects ; Intestinal Absorption/physiology ; Kidney Failure, Chronic/drug therapy ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Kidney Tubules, Proximal/physiopathology ; Lanthanum/pharmacology ; Lanthanum/therapeutic use ; Parathyroid Hormone/blood ; Phosphates/blood ; Phosphates/urine ; Polyamines/pharmacology ; Polyamines/therapeutic use ; Renal Dialysis ; Sevelamer
Chemical Substances	Acetates ; Calcium Compounds ; Chelating Agents ; Parathyroid Hormone ; Phosphates ; Polyamines ; Fibroblast Growth Factors (62031-54-3) ; Lanthanum (6I3K30563S) ; fibroblast growth factor 23 (7Q7P4S7RRE) ; Sevelamer (9YCX42I8IU) ; calcium acetate (Y882YXF34X)
Language	English
Publishing date	2011-09-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2490366-8
ISSN	1759-507X ; 1759-5061
ISSN (online)	1759-507X
ISSN	1759-5061
DOI	10.1038/nrneph.2011.112
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Zs.A 6334: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MG 107: Show issues

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Article ; Online: Long-term outcomes of persistent disease and relapse in primary membranous nephropathy.

Kanigicherla, Durga A K / Short, Colin D / Roberts, Stephen A / Hamilton, Patrick / Nikam, Milind / Harris, Shelley / Brenchley, Paul E C / Venning, Michael C

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2016 Volume 31, Issue 12, Page(s) 2108–2114

Abstract: Background: Primary membranous nephropathy is associated with variable clinical course ranging from spontaneous remission to slow progression to end stage renal failure. Achieving remission confers better renal survival in primary membranous nephropathy ...

Abstract	Background: Primary membranous nephropathy is associated with variable clinical course ranging from spontaneous remission to slow progression to end stage renal failure. Achieving remission confers better renal survival in primary membranous nephropathy (PMN). Longer term outcomes such as patient survival and relapse of active disease remain poorly understood. Methods: We performed a retrospective study of 128 consecutive adult patients diagnosed with biopsy proven PMN at a single UK centre between 1980 and 2010. These patients were followed prospectively over a median of 128 months. We assessed impact of persistent disease and relapse on Stage 5 chronic kidney disease (CKD-5) and patient survival and present longer term cumulative incidences of different end points. Results: One hundred patients achieved partial remission (PartRem) and 28 patients did not achieve remission (NoRem). Nine per cent of patients achieving first remission developed CKD-5 and 75% of those with NoRem developed CKD-5 [hazard ratio (HR) 0.07, 95% confidence interval 0.03-0.19). Relapse following PartRem occurred in 31 patients (31%) during follow-up and was significantly associated with progression to CKD-5. Progression to CKD-5 was strongly associated with death (47 versus 6%, HR 23.4; P < 0.01). Cumulative incidence at 15 years following first presentation included: death, 14%; CKD-5, 28%; and relapse 40% (in patients who achieved first remission). Conclusions: Our data strongly suggest that mortality in PMN is seen in patients with disease progression to CKD-5. Achieving remission is strongly associated with improved renal survival after first presentation and following relapse. We suggest that patients who achieve remission should be followed up in longer term, and better strategies to help improve outcomes are needed in clinical practice.
MeSH term(s)	Adolescent ; Adult ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glomerulonephritis, Membranous/mortality ; Glomerulonephritis, Membranous/pathology ; Glomerulonephritis, Membranous/therapy ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/pathology ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Proportional Hazards Models ; Proteinuria/mortality ; Proteinuria/pathology ; Proteinuria/therapy ; Recurrence ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2016-12
Publishing country	England
Document type	Journal Article
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfv435
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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 329: Show issues

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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