نفروپاتی غشایی مانند لوپوس

سام, رامین and جوشی, آمیت and جیمس, سام and جن, کونک and امانی, فیروز and هارت, پیتر and شوارتز, ملوین (1394) نفروپاتی غشایی مانند لوپوس. Clinical and Experimental Nephrology ــ 19 (3). pp. 395-402. شاپا 1437-7799


Official URL: http://link.springer.com/article/10.1007/s10157-01...


Lupus-like membranous nephropathy: Is it lupus or not

English 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.

Item Type:Article
زبان سند : انگلیسی
نویسنده مسئول :رامین سام
نویسنده :فیروز امانی
Additional Information:Impact Factor:(2014)2.02 Indexing in: ISI, PubMed/Medline, Scopus, Embase
کلیدواژه ها (انگلیسی):Membranous GN , Systemic lupus , Idiopathic membranous , Pathological features of lupus , membranous
Subjects:WD Nutrition Disease and metabolic diseases
WH Hemic and Lymphatic System
Divisions:Faculty of Medicine > Department of Pediatrics , Community Medicine
ID Code:6819
Deposited By: Dr Firouz Amani
Deposited On:03 May 1394 05:30
Last Modified:22 Feb 1399 07:39

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