Original ArticlesClinical Nephrology
Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy
Daniel C. Cattran, Heather N. Reich, S. Joseph Kim and Stéphan Troyanov
CJASN July 2011, 6 (7) 1591-1598; DOI: https://doi.org/10.2215/CJN.11001210
Daniel C. Cattran
Heather N. Reich
S. Joseph Kim
Stéphan Troyanov
Figures & Data Supps
Article Figures & Data
Patient selection in the three eras of interest.
Renal survival of three separate eras.
Survival among propensity-matched treated and control patients.
Baseline and follow-up information
P (post hoc)
n 86 145 49
female gender (%) 41 30 32 >0.1
age (years) 44 ± 15 49 ± 14 53 ± 16 0.01 (1 < 2,3)
CrCl (ml/min per 1.73 m2) 83 ± 31 74 ± 26 83 ± 33 0.03 (2 < 1,3)
initial (g/d) 5.3 (3.7 to 9.0) 6.2 (3.5 to 10.4) 6.6 (3.2 to 10.0) >0.1
peak (g/d) 7.8 (4.4 to 11.4) 10.2 (6.0 to 17.4) 10.0 (5.9 to 14.9) <0.01 (1 < 2,3)
MAP (mmHg) 101 ± 15 102 ± 12 99 ± 13 >0.1
number of antihypertensive medications 0 (0 to 1) 0 (0 to 1) 0 (0 to 1) >0.1
Length of follow-up (months) 58 (38 to 83) 38 (21 to 57) 51 (26 to 66) <0.01 (1 > 2,3)
Therapy during follow-up
number of antihypertensive medications 0.3 (0.0 to 0.6) 0.4 (0.0 to 1.0) 1.0 (0.7 to 1.5) <0.01 (1,2 < 3)
RAS blockade (%) 0 27 90 <0.01 (1 < 2<3)
duration (% of patient follow-up) – 32 (8 to 62) 76 (47 to 96) <0.01
immunosuppressive therapy
none (%) 55 46 39 0.02 (1 < 2,3)
not currently recommended (%) 38 31 26
currently recommended (%) 7 23 35
Clinical follow-up
MAP (mmHg) 101 ± 10 100 ± 9 95 ± 8 0.02 (1,2 > 3)
change from peak to last (g/d) −4.6 (−8.6 to −2.2) −6.4 (−11.0 to −2.7) −5.3 (−12.7 to −2.4) 0.06
no remission (%) 24 37 18 0.02 (2 > 1,3)
slope (ml/min per 1.73 m2 per year) −2.8 ± 6.7 −5.0 ± 10.3 −2.6 ± 6.0 0.08
renal survival See Figure 2
Values are expressed as mean ± SD or median (interquartile range). CrCl, creatinine clearance; MAP, mean arterial pressure; RAS, renin-angiotensin system.
Differences in clinical presentation between patients receiving no or currently recommended immunosuppressive therapy during follow-up
Treatment Group
n 132 57
Patients per era (era 1, 2, 3, respectively) 47, 66, 19 6, 34, 17
At presentation
female gender (%) 40 25 0.04
age 47 ± 16 49 ± 14 >0.1
CrCl (ml/min per 1.73 m2) 81 ± 31 74 ± 24 >0.1
MAP (mmHg) 101 ± 13 103 ± 12 >0.1
proteinuria (g/d)
initial 4.9 (2.9 to 8.6) 8.8 (5.2 to 11.5) <0.01
peak 6.4 (4.0 to 10.0) 13.3 (10.8 to 20.5) <0.01
number of antihypertensive drugs 0 (0 to 1) 0 (0 to 1)
CrCl, Creatinine clearance; MAP, mean arterial pressure.
Propensity score analysis on the effect of immunosuppressive therapy
Patients per era (era 1, 2, 3, respectively) 11, 20, 8 5, 25, 9 >0.1
female gender (%) 18 26 >0.1
initial 9.5 (6.4 to 11.7) 6.9 (5.1 to 10.5) >0.1
peak 12.2 (9.1 to 16.8) 11.5 (10.0 to 15.6) >0.1
number of antihypertensive drugs 0 (0 to 1) 0 (0 to 1) >0.1
number of antihypertensive drugs 0.7 (0.3 to 1.2) 0.7 (0.1 to 1.3) >0.1
RAS blockade (%) 41 39 >0.1
duration (% of patient follow-up) 43 (7 to 74) 45 (28 to 85) >0.1
cyclophosphamide/chlorambucil (n) – 32/1a By design
cyclosporine (n) – 12a
corticosteroids (n) – 25
MAP (mmHg) 102 ± 9 101 ± 9 >0.1
change from peak to last (g/d) −4.7 (−9.8 to −1.6) −9.1 (−14.4 to −5.2) 0.01
absence of remission (%) 56 21 0.01
slope (ml/min per 1.73 m2 per year) −6.1 ± 11.0 −3.6 ± 6. 8 >0.1
Values are expressed as mean ± SD or median (interquartile range). CrCl, Creatinine clearance; MAP, mean arterial pressure.
↵a All patients received either cytotoxic or cyclosporine treatment (six patients received both during follow-up).
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Daniel C. Cattran, Heather N. Reich, S. Joseph Kim, Stéphan Troyanov
CJASN Jul 2011, 6 (7) 1591-1598; DOI: 10.2215/CJN.11001210
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