Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 ± 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission.
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机译:自发缓解是特发性膜性肾病的一个众所周知的特征,但是缺乏描述缓解和长期预后的预测因子的当代研究。我们对328例因特发性膜性肾病引起的肾病综合征患者进行了一项回顾性,多中心队列研究,该患者最初接受了保守治疗。自发缓解发生在104名(32%)患者中:诊断后蛋白尿逐渐下降,直到疾病缓解14.7±11.4个月。尽管在基线蛋白尿水平较低的情况下自发缓解更为频繁,但在大量蛋白尿患者中也经常发生自发缓解:基线蛋白尿的患者中8%至12 g / 24 h为26%,蛋白尿> 12 g / 24 h的患者为22% 。在随访的第一年中,基线血清肌酐和蛋白尿,使用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂的治疗以及蛋白尿比基线下降> 50%是自发缓解的重要独立预测因素。只有六名患者(5.7%)经历了肾病综合征的复发。自发缓解患者的死亡和ESRD发生率显着降低。总之,在膜性肾病引起的肾病综合征患者中,自发缓解很常见,并且具有良好的长期预后,复发率低。在第一年中,蛋白尿比基线减少> 50%表示自发缓解。
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