Glomerulonefryt – Rokowania, prognozy i postęp choroby

Glomerulonefryt
Rokowania, prognozy i postęp choroby

Glomerulonefryt (GN) stanowi istotną przyczynę przewlekłej choroby nerek (PChN) i schyłkowej niewydolności nerek (ESRD), a rokowanie jest silnie zróżnicowane w zależności od typu choroby, etiologii oraz odpowiedzi na leczenie. Choroby takie jak minimal change disease cechują się dobrym rokowaniem przy odpowiedzi na kortykosteroidy, natomiast nefropatia błoniasta i nefropatia IgA wykazują zmienną progresję, z ryzykiem ESRD wzrastającym wraz z wiekiem i nasileniem białkomoczu. Kluczowymi prognostycznymi wskaźnikami są wartość eGFR przy rozpoznaniu i po 12 miesiącach, gdzie tempo spadku eGFR ≤1 ml/min/1,73 m² rocznie jest korzystne, oraz poziom białkomoczu, gdzie UPCR ≤0,44 g/g (50 mg/mmol) i redukcja o 50% w ciągu roku wiążą się z lepszymi wynikami. Dodatkowo, biomarkery sercowe (troponina I, NT-proBNP) oraz cechy histologiczne, takie jak pęknięcie torebki Bowmana, mają istotne znaczenie prognostyczne, szczególnie w zapaleniu naczyń związanym z ANCA.

Prognozy Glomerulonefrytu (Outcome Prediction)

Rokowanie w spektrum nefropatii nefrotycznej
Rokowanie w spektrum nefropatii zapalnych
Czynniki prognostyczne w glomerulonefrycie
Szczególne typy glomerulonefrytu i ich rokowanie
Ogólne rokowanie w glomerulonefrycie
Podsumowanie czynników prognostycznych
Kolejne rozdziały

Prognozy Glomerulonefrytu (Outcome Prediction)

Glomerulonefryt (GN) jest jedną z głównych przyczyn przewlekłej choroby nerek (PChN) i w konsekwencji niewydolności nerek. Rokowanie w różnych typach glomerulonefrytu może znacznie się różnić w zależności od etiologii, prezentacji klinicznej, czasu rozpoczęcia leczenia oraz odpowiedzi na terapię. Przewidywanie długoterminowych wyników leczenia na wczesnym etapie choroby ma kluczowe znaczenie dla optymalizacji opieki nad pacjentem.¹²

Rokowanie w spektrum nefropatii nefrotycznej

Rokowanie w poszczególnych typach glomerulonefrytu różni się znacząco:

Choroba zmian minimalnych (minimal change disease) – charakteryzuje się bardzo dobrym rokowaniem we wszystkich grupach wiekowych, jeśli występuje odpowiedź na leczenie kortykosteroidami. Główna zachorowalność wiąże się z działaniami niepożądanymi leków.³
Nefropatia błoniasta (membranous nephropathy) – około jedna trzecia pacjentów z białkomoczem w zakresie subnefrotycznym reaguje na leczenie zachowawcze. Obserwowano również spontaniczne remisje w przypadkach masywnego białkomoczu. U pacjentów z objawami zespołu nerczycowego remisja może nastąpić w ciągu 6 miesięcy pod warunkiem odpowiedniego leczenia.⁴
Nefropatia związana z HIV – odpowiednie leczenie spowalnia jej progresję, jednak w przypadku postępu do schyłkowej niewydolności nerek (ESRD) konieczny może być przeszczep nerki.⁵
Amyloidoza łańcuchów lekkich (AL) – progresja do ESRD zajmuje zwykle 2-3 lata, podczas gdy w przypadku amyloidozy typu AA remisję można osiągnąć poprzez zidentyfikowanie i leczenie choroby podstawowej.⁶

Rokowanie w spektrum nefropatii zapalnych

Ostre poinfekcyjne kłębuszkowe zapalenie nerek (PSGN) – ma doskonałe rokowanie, szczególnie u dzieci, z całkowitym wyzdrowieniem zwykle w ciągu 6-8 tygodni. U dorosłych około 50% pacjentów nadal wykazuje zmniejszoną funkcję nerek, nadciśnienie lub utrzymujące się białkomocz.⁷
Nefropatia IgA – często przebiega łagodnie, jednak u niektórych pacjentów następuje stopniowa progresja do ESRD, a częstość ESRD wzrasta z wiekiem. Rokowanie można do pewnego stopnia przewidzieć na podstawie klasyfikacji Oxford. Złe rokowanie wskazują: białkomocz w zakresie nerczycowym, nadciśnienie, wysoki poziom kreatyniny w surowicy oraz rozległe włóknienie jelitowe nerek w momencie prezentacji.⁸⁹
Plamica Henocha-Schönleina – typowo jest chorobą samoograniczającą się, z doskonałym rokowaniem u pacjentów bez zajęcia nerek. Większość pacjentów w pełni wraca do zdrowia w ciągu czterech tygodni. Długoterminowa zachorowalność zależy od stopnia zajęcia nerek. Około 1% pacjentów rozwinie ESRD i będzie wymagać przeszczepu nerki.¹⁰
Glomerulonefryt pauci-immunologiczny – przy szybkim i intensywnym leczeniu zazwyczaj następuje remisja (75% przypadków), jednak nieleczony wiąże się z bardzo złym rokowaniem.¹¹
Błoniasto-rozplemowe kłębuszkowe zapalenie nerek (MPGN) – mimo terapii nieuchronnie prowadzi do ESRD. Częstość nawrotów jest wysoka nawet po przeszczepie nerki.¹²

Czynniki prognostyczne w glomerulonefrycie

Istnieje kilka kluczowych czynników prognostycznych, które mogą pomóc w przewidywaniu długoterminowych wyników u pacjentów z glomerulonefrytem:

Parametry kliniczne i laboratoryjne

Wskaźnik filtracji kłębuszkowej (eGFR) – wartość eGFR przy rozpoznaniu oraz po 12 miesiącach jest silnie związana z przeżyciem nerek. Dla uniknięcia niewydolności nerek w ciągu całego życia, tempo spadku eGFR powinno być utrzymane na poziomie ≤1 ml/min/1,73 m² rocznie.¹³¹⁴
Białkomocz – zarówno średni stosunek białka do kreatyniny w moczu (UPCR) ≤0,44 g/g (50 mg/mmol), jak i 50% redukcja UPCR w ciągu 12 miesięcy (od diagnozy lub po 6 miesiącach) wiąże się ze znacznie niższym ryzykiem niewydolności nerek. UPCR ≤0,88 g/g (100 mg/mmol) po roku jest związany z istotnie niższym ryzykiem niewydolności nerek.¹⁵
Biomarkery kardiologiczne – rutynowo dostępne biomarkery sercowe, takie jak troponina I i N-końcowy fragment propeptydu natriuretycznego typu B (NT-proBNP), mogą przewidywać wystąpienie poważnych niepożądanych zdarzeń sercowo-naczyniowych (MACE) u pacjentów z GN. Podwyższony poziom NT-proBNP i/lub troponiny I wykazuje statystycznie istotną korelację z wystąpieniem MACE u pacjentów z glomerulonefrytem.¹⁶¹⁷

Parametry histopatologiczne

Pęknięcie torebki Bowmana (Bowman’s capsule rupture, BCR) – badanie wykazało, że uwzględnienie tego parametru poprawia skuteczność systemów prognostycznych w przewidywaniu wyników w zapaleniu naczyń związanym z przeciwciałami ANCA (AAV). Dodanie BCR do modeli obejmujących tylko klasyfikację Berdena lub ARRS (ANCA Renal Risk Score) znacząco poprawiło wydajność prognostyczną.¹⁸
Powtórna biopsja nerki – w przypadku toczniowego zapalenia nerek (LN) rozbieżne wzorce między danymi klinicznymi a histologicznymi w czasie powtórnej biopsji nerki skłoniły do badań nad rolą informacji na poziomie tkanki w dostosowywaniu leczenia i przewidywaniu długoterminowych wyników nerkowych. Gromadzące się dowody zdecydowanie potwierdzają użyteczność powtórnych biopsji nerek jako integralnej części oceny leczenia, w tym u pacjentów z LN wykazujących odpowiednią odpowiedź kliniczną.¹⁹

Szczególne typy glomerulonefrytu i ich rokowanie

Toczniowe zapalenie nerek

Toczniowe zapalenie nerek (LN) jest ciężkim objawem SLE, charakteryzującym się podśródbłonkowymi i/lub podnabłonkowymi złogami kompleksów immunologicznych w zajętej nerce, co prowadzi do rozległych uszkodzeń i utraty nefronów w fazie ostrej, a ostatecznie do nieodwracalnych przewlekłych uszkodzeń i upośledzenia funkcji nerek, jeśli nie jest skutecznie leczone.²⁰

Wczesna odpowiedź na leczenie wiąże się z korzystnymi wynikami nerkowymi, jednak brakuje wczesnych predyktorów upośledzenia czynności nerek. Dlatego przewidywanie długoterminowego wyniku nerkowego na wczesnych etapach choroby ma ogromne znaczenie. Obecne badania koncentrują się na identyfikacji klinicznych, histologicznych i molekularnych markerów aktywności, uszkodzenia, odpowiedzi na leczenie i rokowania nerkowego.²¹²²

Wczesne zmniejszenie poziomu białkomoczu w ciągu 6 miesięcy leczenia wykazało zdolność do przewidywania bardziej korzystnego długoterminowego wyniku nerkowego w porównaniu z pacjentami z utrzymującym się wysokim białkomoczem. Jednakże, chociaż ten cel kliniczny mógł zidentyfikować pacjentów z dobrym wynikiem nerkowym z wysoką dodatnią wartością predykcyjną, nie mógł przewidzieć wyniku u pacjentów, którzy nie osiągnęli celu, ponieważ ujemna wartość predykcyjna tego punktu odcięcia białkomoczu była niska w dwóch z trzech badań.²³

Nefropatia IgA

Nefropatia IgA może postępować do niewydolności nerek, a ocena ryzyka wkrótce po rozpoznaniu ma zalety zarówno dla postępowania klinicznego, jak i rozwoju nowych metod terapeutycznych. W dużej kohorcie pacjentów z nefropatią IgA mediana przeżycia nerek wynosiła 11,4 roku (95% przedział ufności: 10,5-12,5), średni wiek w momencie niewydolności nerek/śmierci wynosił 48 lat, a większość pacjentów postępowała do niewydolności nerek w ciągu 10-15 lat.²⁴

Wyniki w tej dużej kohorcie nefropatii IgA są generalnie złe, przy czym u niewielu pacjentów można się spodziewać uniknięcia niewydolności nerek w ciągu ich życia. Co istotne, pacjenci tradycyjnie uważani za grupę niskiego ryzyka, z białkomoczem ≤0,88 g/g (100 mg/mmol), mieli wysokie wskaźniki niewydolności nerek w ciągu 10 lat. Na podstawie eGFR i wieku w momencie rozpoznania, prawie wszyscy pacjenci byli zagrożeni progresją do niewydolności nerek w przewidywanym czasie życia, chyba że utrzymywany był wskaźnik utraty eGFR ≤1 ml/min na 1,73 m² rocznie.²⁵²⁶

Włókienkowe kłębuszkowe zapalenie nerek

Włókienkowe kłębuszkowe zapalenie nerek (FGN) jest heterogenną chorobą związaną ze znacznym ryzykiem ESRD i śmiertelności. Przebieg choroby może być uzależniony od typu histologicznego glomerulonefrytu i czasu rozpoczęcia terapii. Około jedna trzecia pacjentów szybko rozwija ESRD w średnim czasie 8 miesięcy.²⁷

FGN w kontekście błoniastego kłębuszkowego zapalenia nerek (MGN) wydaje się mieć bardziej korzystne rokowanie w porównaniu z typem mezangialnym (MES) i błoniasto-rozplemowym (MPGN), a białkomocz w zakresie nerczycowym wiąże się ze złym rokowaniem. Żaden z sześciu pacjentów, którzy byli leczeni środkami immunosupresyjnymi w czasie, gdy ich funkcja nerek była prawidłowa, nie doświadczył ESRD w średnim okresie obserwacji wynoszącym 46 miesięcy. To odkrycie potwierdza hipotezę, że wczesne leczenie immunosupresyjne może poprawić wyniki i opóźnić zmniejszenie funkcji nerek. Sukces terapii immunosupresyjnej może również zależeć od typu glomerulonefrytu obserwowanego w mikroskopie świetlnym.²⁸

Glomerulonefryt C3 i IC-MPGN

W badaniu obejmującym pacjentów z glomerulopatią C3 (C3G) i błoniasto-rozplemowym kłębuszkowym zapaleniem nerek z kompleksami immunologicznymi (IC-MPGN), 63% pacjentów z C3G i 70% pacjentów z IC-MPGN osiągnęło niewydolność nerek podczas obserwacji po medianie 9,7 roku. Przeżycie nerek było silnie związane z eGFR na początku badania i w punkcie czasowym 12 miesięcy. W przeciwieństwie do tego, zarówno średni w czasie UPCR ≤0,44 g/g (50 mg/mmol), jak i 50% redukcja UPCR po 12 miesiącach (od diagnozy lub po 6 miesiącach) były silnie związane z niższym ryzykiem niewydolności nerek.²⁹

Badanie to wykazało, że białkomocz krótko po rozpoznaniu jest silnym predyktorem długoterminowych wyników oraz że UPCR ≤0,88 g/g (100 mg/mmol) po roku wiąże się ze znacznie niższym ryzykiem niewydolności nerek.³⁰

Ogólne rokowanie w glomerulonefrycie

Glomerulonefryt może być tymczasowy i odwracalny lub może się pogarszać. Postępujący glomerulonefryt może prowadzić do przewlekłej niewydolności nerek, zmniejszonej funkcji nerek i schyłkowej niewydolności nerek. Jeśli pacjent ma zespół nerczycowy i można go kontrolować, można również kontrolować inne objawy. Jeśli nie można go kontrolować, może rozwinąć się schyłkowa niewydolność nerek.³¹

W ostatniej dekadzie poczyniono znaczne postępy w opóźnianiu progresji glomerulonefrytu. Trwają intensywne badania nad czynnikami prognostycznymi, które mogą pomóc w przewidywaniu wyników i dostosowywaniu leczenia do indywidualnych potrzeb pacjentów.³²

Podsumowanie czynników prognostycznych

Na podstawie dostępnych danych można zidentyfikować kilka kluczowych czynników prognostycznych w glomerulonefrycie:

Funkcja nerek przy rozpoznaniu – wyjściowy eGFR jest silnym predyktorem długoterminowych wyników.³³
Białkomocz – stopień białkomoczu i jego zmniejszenie w odpowiedzi na leczenie są silnymi wskaźnikami prognostycznymi.³⁴³⁵
Nadciśnienie – obecność nadciśnienia przy rozpoznaniu jest związana z gorszymi wynikami.³⁶
Cechy histologiczne – określone cechy w biopsji nerki, takie jak stopień włóknienia śródmiąższowego, pęknięcie torebki Bowmana i wzorzec uszkodzenia kłębuszków nerkowych, mają wartość prognostyczną.³⁷³⁸
Biomarkery sercowe – podwyższone poziomy biomarkerów takich jak troponina I i NT-proBNP mogą przewidywać ryzyko zdarzeń sercowo-naczyniowych u pacjentów z GN.³⁹
Wczesna odpowiedź na leczenie – zmniejszenie białkomoczu i stabilizacja funkcji nerek w ciągu pierwszych 6-12 miesięcy leczenia są związane z lepszymi długoterminowymi wynikami.⁴⁰⁴¹

Identyfikacja tych czynników prognostycznych może pomóc w stratyfikacji ryzyka pacjentów z glomerulonefrytem i dostosowaniu strategii leczenia w celu poprawy długoterminowych wyników.

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Materiały źródłowe

#1 Medicina | Special Issue : Clinical Research on Glomerulonephritis
https://www.mdpi.com/journal/medicina/special_issues/QD8LHV43U7
Glomerulonephritis is one of the major causes leading to end-stage kidney disease. Many advances have been made for delaying the progression of glomerulonephritis over the last decade. […] We are pleased to invite you to contribute to this Special Issue by submitting clinical research articles or reviews in glomerulonephritis investigating outcome prediction equations and exploring how to ensure early and precise diagnosis, develop better diagnostic tools or disease markers, and implement best practices.
#2 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Lupus nephritis (LN) is a severe manifestation of SLE, characterised by subendothelial and/or subepithelial immune complex depositions in the afflicted kidney, resulting in extensive injury and nephron loss during the acute phase and eventually chronic irreversible damage and renal function impairment if not treated effectively. […] The therapeutic management of LN has improved during the last decades, but the imperative need for consensual outcome measures remains. […] While it is known that early response to treatment is coupled with favourable renal outcomes, early predictors of renal function impairment are lacking. […] For this reason, prediction of the long-term renal outcome at early stages of the disease is of vital importance. […] Thus, several studies have sought to identify early clinical features, laboratory tests and molecular mechanisms that are associated with unfavourable renal prognosis, in order to optimise the surveillance and interventions in these patients.
#3 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
With timely and avid treatment, pauci-immune GN usually remits (75% of cases). But if left untreated, it carries a very poor prognosis. […] Membranoproliferative glomerulonephritis progresses to ESRD inevitably, despite therapy. Also, the frequency of recurrence is high even after a kidney transplant. […] Among the Nephrotic Spectrum Diseases: Minimal change disease has a very good prognosis for all ages if there is a response to corticosteroid therapy. The primary morbidity is related to the adverse effects of the medications. Approximately a third of patients with membranous nephropathy who have subnephrotic proteinuria respond to conservative management. Spontaneous remission has also been seen in cases of heavy proteinuria. However, in others with features of nephrotic syndrome, remission may take up to 6 months, provided adequate treatment is given. Appropriate treatment does slow the progression of HIV-associated nephropathy, but with progression into ESRD, a kidney transplant may be necessary. Amyloid light-chain (AL) amyloidosis takes 2 to 3 years for progression towards ESRD, while for amyloid A (AA) amyloidosis, remission can be achieved by identifying and managing the underlying disease.
#4 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
With timely and avid treatment, pauci-immune GN usually remits (75% of cases). But if left untreated, it carries a very poor prognosis. […] Membranoproliferative glomerulonephritis progresses to ESRD inevitably, despite therapy. Also, the frequency of recurrence is high even after a kidney transplant. […] Among the Nephrotic Spectrum Diseases: Minimal change disease has a very good prognosis for all ages if there is a response to corticosteroid therapy. The primary morbidity is related to the adverse effects of the medications. Approximately a third of patients with membranous nephropathy who have subnephrotic proteinuria respond to conservative management. Spontaneous remission has also been seen in cases of heavy proteinuria. However, in others with features of nephrotic syndrome, remission may take up to 6 months, provided adequate treatment is given. Appropriate treatment does slow the progression of HIV-associated nephropathy, but with progression into ESRD, a kidney transplant may be necessary. Amyloid light-chain (AL) amyloidosis takes 2 to 3 years for progression towards ESRD, while for amyloid A (AA) amyloidosis, remission can be achieved by identifying and managing the underlying disease.
#5 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
With timely and avid treatment, pauci-immune GN usually remits (75% of cases). But if left untreated, it carries a very poor prognosis. […] Membranoproliferative glomerulonephritis progresses to ESRD inevitably, despite therapy. Also, the frequency of recurrence is high even after a kidney transplant. […] Among the Nephrotic Spectrum Diseases: Minimal change disease has a very good prognosis for all ages if there is a response to corticosteroid therapy. The primary morbidity is related to the adverse effects of the medications. Approximately a third of patients with membranous nephropathy who have subnephrotic proteinuria respond to conservative management. Spontaneous remission has also been seen in cases of heavy proteinuria. However, in others with features of nephrotic syndrome, remission may take up to 6 months, provided adequate treatment is given. Appropriate treatment does slow the progression of HIV-associated nephropathy, but with progression into ESRD, a kidney transplant may be necessary. Amyloid light-chain (AL) amyloidosis takes 2 to 3 years for progression towards ESRD, while for amyloid A (AA) amyloidosis, remission can be achieved by identifying and managing the underlying disease.
#6 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
With timely and avid treatment, pauci-immune GN usually remits (75% of cases). But if left untreated, it carries a very poor prognosis. […] Membranoproliferative glomerulonephritis progresses to ESRD inevitably, despite therapy. Also, the frequency of recurrence is high even after a kidney transplant. […] Among the Nephrotic Spectrum Diseases: Minimal change disease has a very good prognosis for all ages if there is a response to corticosteroid therapy. The primary morbidity is related to the adverse effects of the medications. Approximately a third of patients with membranous nephropathy who have subnephrotic proteinuria respond to conservative management. Spontaneous remission has also been seen in cases of heavy proteinuria. However, in others with features of nephrotic syndrome, remission may take up to 6 months, provided adequate treatment is given. Appropriate treatment does slow the progression of HIV-associated nephropathy, but with progression into ESRD, a kidney transplant may be necessary. Amyloid light-chain (AL) amyloidosis takes 2 to 3 years for progression towards ESRD, while for amyloid A (AA) amyloidosis, remission can be achieved by identifying and managing the underlying disease.
#7 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
Prognosis among the Nephritic Spectrum Diseases: PSGN has an excellent prognosis, especially in children with complete recovery, usually occurring within 6 to 8 weeks. In adults, around 50% of the patients continue to have reduced renal function, hypertension, or persistent proteinuria. Frequently IgA nephropathy has a benign course. Others gradually progress to ESRD, with ESRD frequency increasing with age. Prognosis is predictable, to some extent, based on the Oxford classification. Additionally, on presentation, nephrotic range proteinuria, hypertension, high serum creatinine level, and widespread intestinal fibrosis of the kidneys indicate a poor prognosis. […] Henoch-Schnlein purpura is typically a self-limited illness that demonstrates an excellent prognosis in patients without renal involvement. The majority of patients fully recover in four weeks. The long-term morbidity of Henoch-Schnlein purpura depends on the extent of renal involvement. Approximately 1% of patients with Henoch-Schnlein purpura will develop ESRD and require renal transplantation.
#8 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
Prognosis among the Nephritic Spectrum Diseases: PSGN has an excellent prognosis, especially in children with complete recovery, usually occurring within 6 to 8 weeks. In adults, around 50% of the patients continue to have reduced renal function, hypertension, or persistent proteinuria. Frequently IgA nephropathy has a benign course. Others gradually progress to ESRD, with ESRD frequency increasing with age. Prognosis is predictable, to some extent, based on the Oxford classification. Additionally, on presentation, nephrotic range proteinuria, hypertension, high serum creatinine level, and widespread intestinal fibrosis of the kidneys indicate a poor prognosis. […] Henoch-Schnlein purpura is typically a self-limited illness that demonstrates an excellent prognosis in patients without renal involvement. The majority of patients fully recover in four weeks. The long-term morbidity of Henoch-Schnlein purpura depends on the extent of renal involvement. Approximately 1% of patients with Henoch-Schnlein purpura will develop ESRD and require renal transplantation.
#9
https://journals.lww.com/cjasn/fulltext/2023/06000/long_term_outcomes_in_iga_nephropathy.9.aspx
IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. […] The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. […] Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria 0.88 g/g (100 mg/mmol), had high rates of kidney failure within 10 years. […] On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss 1 ml/min per 1.73 m2 per year was maintained.
#10 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
Prognosis among the Nephritic Spectrum Diseases: PSGN has an excellent prognosis, especially in children with complete recovery, usually occurring within 6 to 8 weeks. In adults, around 50% of the patients continue to have reduced renal function, hypertension, or persistent proteinuria. Frequently IgA nephropathy has a benign course. Others gradually progress to ESRD, with ESRD frequency increasing with age. Prognosis is predictable, to some extent, based on the Oxford classification. Additionally, on presentation, nephrotic range proteinuria, hypertension, high serum creatinine level, and widespread intestinal fibrosis of the kidneys indicate a poor prognosis. […] Henoch-Schnlein purpura is typically a self-limited illness that demonstrates an excellent prognosis in patients without renal involvement. The majority of patients fully recover in four weeks. The long-term morbidity of Henoch-Schnlein purpura depends on the extent of renal involvement. Approximately 1% of patients with Henoch-Schnlein purpura will develop ESRD and require renal transplantation.
#11 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
With timely and avid treatment, pauci-immune GN usually remits (75% of cases). But if left untreated, it carries a very poor prognosis. […] Membranoproliferative glomerulonephritis progresses to ESRD inevitably, despite therapy. Also, the frequency of recurrence is high even after a kidney transplant. […] Among the Nephrotic Spectrum Diseases: Minimal change disease has a very good prognosis for all ages if there is a response to corticosteroid therapy. The primary morbidity is related to the adverse effects of the medications. Approximately a third of patients with membranous nephropathy who have subnephrotic proteinuria respond to conservative management. Spontaneous remission has also been seen in cases of heavy proteinuria. However, in others with features of nephrotic syndrome, remission may take up to 6 months, provided adequate treatment is given. Appropriate treatment does slow the progression of HIV-associated nephropathy, but with progression into ESRD, a kidney transplant may be necessary. Amyloid light-chain (AL) amyloidosis takes 2 to 3 years for progression towards ESRD, while for amyloid A (AA) amyloidosis, remission can be achieved by identifying and managing the underlying disease.
#12 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
With timely and avid treatment, pauci-immune GN usually remits (75% of cases). But if left untreated, it carries a very poor prognosis. […] Membranoproliferative glomerulonephritis progresses to ESRD inevitably, despite therapy. Also, the frequency of recurrence is high even after a kidney transplant. […] Among the Nephrotic Spectrum Diseases: Minimal change disease has a very good prognosis for all ages if there is a response to corticosteroid therapy. The primary morbidity is related to the adverse effects of the medications. Approximately a third of patients with membranous nephropathy who have subnephrotic proteinuria respond to conservative management. Spontaneous remission has also been seen in cases of heavy proteinuria. However, in others with features of nephrotic syndrome, remission may take up to 6 months, provided adequate treatment is given. Appropriate treatment does slow the progression of HIV-associated nephropathy, but with progression into ESRD, a kidney transplant may be necessary. Amyloid light-chain (AL) amyloidosis takes 2 to 3 years for progression towards ESRD, while for amyloid A (AA) amyloidosis, remission can be achieved by identifying and managing the underlying disease.
#13 Clinical Predictors of Long-term Outcomes in C3 Glomerulopathy and Immune-Complex Membranoproliferative Glomerulonephritis within the UK RaDaR Registry | medRxiv
https://www.medrxiv.org/content/10.1101/2024.02.03.24301605v1.full-text
85/135 (63%) C3G and 107/152 (70%) IC-MPGN patients reached kidney failure over follow-up after a median of 9.7 years (95% CI 7.6-12.4). […] Kidney survival was strongly associated with eGFR at baseline and 12-month timepoints (p0.001). […] In contrast, both a time averaged 0.44g/g (50mg/mmol) and 50% reduction in UPCR at 12 months (from either diagnosis or 6-months) was strongly associated with a lower risk of kidney failure (p0.002). […] We demonstrate that proteinuria a short time after diagnosis is a strong predictor of long-term outcomes and that a UPCR 0.88g/g (100mg/mol) at 1 year is associated with a substantially lower kidney failure risk. […] We provide quantitative descriptions of the relationships between early changes in both eGFR and proteinuria, and long-term renal outcomes.
#14
https://journals.lww.com/cjasn/fulltext/2023/06000/long_term_outcomes_in_iga_nephropathy.9.aspx
A striking observation in our cohort was that almost all patients with IgA nephropathy were expected to progress to kidney failure within their lifetime, regardless of age or eGFR at diagnosis. […] An eGFR decline of 1 ml/min per 1.73 m2 per year must be the target if patients are to avoid kidney failure.
#15 Clinical Predictors of Long-term Outcomes in C3 Glomerulopathy and Immune-Complex Membranoproliferative Glomerulonephritis within the UK RaDaR Registry | medRxiv
https://www.medrxiv.org/content/10.1101/2024.02.03.24301605v1.full-text
85/135 (63%) C3G and 107/152 (70%) IC-MPGN patients reached kidney failure over follow-up after a median of 9.7 years (95% CI 7.6-12.4). […] Kidney survival was strongly associated with eGFR at baseline and 12-month timepoints (p0.001). […] In contrast, both a time averaged 0.44g/g (50mg/mmol) and 50% reduction in UPCR at 12 months (from either diagnosis or 6-months) was strongly associated with a lower risk of kidney failure (p0.002). […] We demonstrate that proteinuria a short time after diagnosis is a strong predictor of long-term outcomes and that a UPCR 0.88g/g (100mg/mol) at 1 year is associated with a substantially lower kidney failure risk. […] We provide quantitative descriptions of the relationships between early changes in both eGFR and proteinuria, and long-term renal outcomes.
#16 Routine cardiac biomarkers for the prediction of incident major adverse cardiac events in patients with glomerulonephritis: a real-world analysis using a global federated database | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03667-y
Glomerulonephritis (GN) is a leading cause of chronic kidney disease (CKD). Major adverse cardiovascular events (MACE) are prolific in CKD. The risk of MACE in GN cohorts is multifactorial. We investigated the prognostic significance of routine cardiac biomarkers, Troponin I and N-terminal pro-BNP (NT-proBNP) in predicting MACE within 5 years of GN diagnosis. […] In GN, routinely available cardiac biomarkers can predict incident MACE. The results suggest the clinical need for cardiovascular and mortality risk profiling in glomerular disease using a combination of clinical and laboratory variables. […] This analysis highlights that routine clinical laboratory cardiac biomarkers, frequently utilised in healthcare settings, can predict incident MACE in patients with GN. Across all GN and sub-groups of primary GN, a raised NT-proBNP and/or Troponin I produced a statistically significant correlation with incident MACE.
#17 Routine cardiac biomarkers for the prediction of incident major adverse cardiac events in patients with glomerulonephritis: a real-world analysis using a global federated database | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03667-y
Given the prevalence of GN and CKD and its direct correlation with MACE outcomes, we must identify those individuals at most risk of MACE to address their modifiable risk factors. By virtue of a diagnosis of GN, patients will require frequent monitoring of blood tests. A method can be developed by testing readily available cardiac biomarkers to calculate CV mortality and risk profiling in patients with glomerular disease using a combination of clinical and laboratory variables.
#18 Bowmanâs capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications | Annals of the Rheumatic Diseases
https://ard.bmj.com/content/81/6/e95
Bowmans capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications. […] The present study demonstrates an improved performance of prognostic systems in predicting AAV outcome after the implementation of BCR, the additional predictive role of which can partly lie in the irreversible loss of nephrons consequent to the segmental glomerulosclerosis caused by BCR. […] Its addition to the model, which included only Berden’s class or ARRS, significantly improved the prognostic performance.
#19 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
The discrepant patterns between clinical and histological data at the time of the repeat kidney biopsy have prompted investigations on the role of the tissue-level information in tailoring treatment and portending the long-term kidney outcome. […] Altogether, accumulating evidence strongly supports the usefulness of repeat kidney biopsies as an integral part of treatment evaluation, including LN patients showing adequate clinical response. […] Hopefully, we will soon identify clinical, molecular or genetic markers, or combinations thereof, which reliably reflect renal histopathology and portend the long-term renal outcome.
#20 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Lupus nephritis (LN) is a severe manifestation of SLE, characterised by subendothelial and/or subepithelial immune complex depositions in the afflicted kidney, resulting in extensive injury and nephron loss during the acute phase and eventually chronic irreversible damage and renal function impairment if not treated effectively. […] The therapeutic management of LN has improved during the last decades, but the imperative need for consensual outcome measures remains. […] While it is known that early response to treatment is coupled with favourable renal outcomes, early predictors of renal function impairment are lacking. […] For this reason, prediction of the long-term renal outcome at early stages of the disease is of vital importance. […] Thus, several studies have sought to identify early clinical features, laboratory tests and molecular mechanisms that are associated with unfavourable renal prognosis, in order to optimise the surveillance and interventions in these patients.
#21 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Lupus nephritis (LN) is a severe manifestation of SLE, characterised by subendothelial and/or subepithelial immune complex depositions in the afflicted kidney, resulting in extensive injury and nephron loss during the acute phase and eventually chronic irreversible damage and renal function impairment if not treated effectively. […] The therapeutic management of LN has improved during the last decades, but the imperative need for consensual outcome measures remains. […] While it is known that early response to treatment is coupled with favourable renal outcomes, early predictors of renal function impairment are lacking. […] For this reason, prediction of the long-term renal outcome at early stages of the disease is of vital importance. […] Thus, several studies have sought to identify early clinical features, laboratory tests and molecular mechanisms that are associated with unfavourable renal prognosis, in order to optimise the surveillance and interventions in these patients.
#22 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Current research in the field focuses on identification of clinical, histological and molecular markers of activity, damage, treatment response and renal prognosis. […] By contrast, early decrease of proteinuria levels over 6months of treatment has shown ability to predict a more favourable long-term renal outcome compared with patients with persistently high-grade proteinuria. […] Nevertheless, while this clinical target could identify patients who had a good renal outcome with a high positive predictive value, it could not predict the outcome of patients who did not achieve the target since the negative predictive value of this proteinuria cut-off was low in two of the three investigations. […] The role of the repeat kidney biopsy in patients with LN has been discussed rigorously during the last decades, but consensus among researchers and physicians has yet to be established.
#23 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Current research in the field focuses on identification of clinical, histological and molecular markers of activity, damage, treatment response and renal prognosis. […] By contrast, early decrease of proteinuria levels over 6months of treatment has shown ability to predict a more favourable long-term renal outcome compared with patients with persistently high-grade proteinuria. […] Nevertheless, while this clinical target could identify patients who had a good renal outcome with a high positive predictive value, it could not predict the outcome of patients who did not achieve the target since the negative predictive value of this proteinuria cut-off was low in two of the three investigations. […] The role of the repeat kidney biopsy in patients with LN has been discussed rigorously during the last decades, but consensus among researchers and physicians has yet to be established.
#24
https://journals.lww.com/cjasn/fulltext/2023/06000/long_term_outcomes_in_iga_nephropathy.9.aspx
IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. […] The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. […] Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria 0.88 g/g (100 mg/mmol), had high rates of kidney failure within 10 years. […] On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss 1 ml/min per 1.73 m2 per year was maintained.
#25
https://journals.lww.com/cjasn/fulltext/2023/06000/long_term_outcomes_in_iga_nephropathy.9.aspx
IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. […] The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. […] Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria 0.88 g/g (100 mg/mmol), had high rates of kidney failure within 10 years. […] On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss 1 ml/min per 1.73 m2 per year was maintained.
#26
https://journals.lww.com/cjasn/fulltext/2023/06000/long_term_outcomes_in_iga_nephropathy.9.aspx
A striking observation in our cohort was that almost all patients with IgA nephropathy were expected to progress to kidney failure within their lifetime, regardless of age or eGFR at diagnosis. […] An eGFR decline of 1 ml/min per 1.73 m2 per year must be the target if patients are to avoid kidney failure.
#27 Outcome of fibrillary glomerulonephritis
https://smw.ch/index.php/smw/article/download/1469/1823?inline=1
FGN is a heterogeneous disease associated with significant risk of ESRD and mortality. […] The course of the disease may be influenced by the histological type of the glomerulonephritis and the time of therapy. […] The data presented confirms the poor prognosis of FGN. About one third of patients rapidly developed ESRD in a mean time of 8 months. […] FGN in the context of MGN seems to have a more favourable prognosis as compared to MES and MPGN and nephrotic range proteinuria is associated with poor outcome. […] None of the six patients, however, who were treated with immunosuppressive agents at a time when their kidney function was normal experienced ESRD over a mean follow up of 46 months, a finding that supports our hypothesis that early immunosuppressive treatment can improve the outcome and delay the decrease of kidney function. […] The success of immunosuppressive therapy may also depend on the type of glomerulonephritis seen by light microscopy. […] In conclusion: Fibrillary glomerulonephritis is a heterogeneous disease associated with significant risk of ESRD and mortality.
#28 Outcome of fibrillary glomerulonephritis
https://smw.ch/index.php/smw/article/download/1469/1823?inline=1
FGN is a heterogeneous disease associated with significant risk of ESRD and mortality. […] The course of the disease may be influenced by the histological type of the glomerulonephritis and the time of therapy. […] The data presented confirms the poor prognosis of FGN. About one third of patients rapidly developed ESRD in a mean time of 8 months. […] FGN in the context of MGN seems to have a more favourable prognosis as compared to MES and MPGN and nephrotic range proteinuria is associated with poor outcome. […] None of the six patients, however, who were treated with immunosuppressive agents at a time when their kidney function was normal experienced ESRD over a mean follow up of 46 months, a finding that supports our hypothesis that early immunosuppressive treatment can improve the outcome and delay the decrease of kidney function. […] The success of immunosuppressive therapy may also depend on the type of glomerulonephritis seen by light microscopy. […] In conclusion: Fibrillary glomerulonephritis is a heterogeneous disease associated with significant risk of ESRD and mortality.
#29 Clinical Predictors of Long-term Outcomes in C3 Glomerulopathy and Immune-Complex Membranoproliferative Glomerulonephritis within the UK RaDaR Registry | medRxiv
https://www.medrxiv.org/content/10.1101/2024.02.03.24301605v1.full-text
85/135 (63%) C3G and 107/152 (70%) IC-MPGN patients reached kidney failure over follow-up after a median of 9.7 years (95% CI 7.6-12.4). […] Kidney survival was strongly associated with eGFR at baseline and 12-month timepoints (p0.001). […] In contrast, both a time averaged 0.44g/g (50mg/mmol) and 50% reduction in UPCR at 12 months (from either diagnosis or 6-months) was strongly associated with a lower risk of kidney failure (p0.002). […] We demonstrate that proteinuria a short time after diagnosis is a strong predictor of long-term outcomes and that a UPCR 0.88g/g (100mg/mol) at 1 year is associated with a substantially lower kidney failure risk. […] We provide quantitative descriptions of the relationships between early changes in both eGFR and proteinuria, and long-term renal outcomes.
#30 Clinical Predictors of Long-term Outcomes in C3 Glomerulopathy and Immune-Complex Membranoproliferative Glomerulonephritis within the UK RaDaR Registry | medRxiv
https://www.medrxiv.org/content/10.1101/2024.02.03.24301605v1.full-text
85/135 (63%) C3G and 107/152 (70%) IC-MPGN patients reached kidney failure over follow-up after a median of 9.7 years (95% CI 7.6-12.4). […] Kidney survival was strongly associated with eGFR at baseline and 12-month timepoints (p0.001). […] In contrast, both a time averaged 0.44g/g (50mg/mmol) and 50% reduction in UPCR at 12 months (from either diagnosis or 6-months) was strongly associated with a lower risk of kidney failure (p0.002). […] We demonstrate that proteinuria a short time after diagnosis is a strong predictor of long-term outcomes and that a UPCR 0.88g/g (100mg/mol) at 1 year is associated with a substantially lower kidney failure risk. […] We provide quantitative descriptions of the relationships between early changes in both eGFR and proteinuria, and long-term renal outcomes.
#31 Glomerulonephritis Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/glomerulonephritis
Glomerulonephritis may be temporary and reversible, or it may get worse. […] Progressive glomerulonephritis may lead to: Chronic kidney failure, Reduced kidney function, End-stage kidney disease. […] If you have nephrotic syndrome and it can be controlled, you may also be able to control other symptoms. If it cannot be controlled, you may develop end-stage kidney disease.
#32 Medicina | Special Issue : Clinical Research on Glomerulonephritis
https://www.mdpi.com/journal/medicina/special_issues/QD8LHV43U7
Glomerulonephritis is one of the major causes leading to end-stage kidney disease. Many advances have been made for delaying the progression of glomerulonephritis over the last decade. […] We are pleased to invite you to contribute to this Special Issue by submitting clinical research articles or reviews in glomerulonephritis investigating outcome prediction equations and exploring how to ensure early and precise diagnosis, develop better diagnostic tools or disease markers, and implement best practices.
#33 Clinical Predictors of Long-term Outcomes in C3 Glomerulopathy and Immune-Complex Membranoproliferative Glomerulonephritis within the UK RaDaR Registry | medRxiv
https://www.medrxiv.org/content/10.1101/2024.02.03.24301605v1.full-text
85/135 (63%) C3G and 107/152 (70%) IC-MPGN patients reached kidney failure over follow-up after a median of 9.7 years (95% CI 7.6-12.4). […] Kidney survival was strongly associated with eGFR at baseline and 12-month timepoints (p0.001). […] In contrast, both a time averaged 0.44g/g (50mg/mmol) and 50% reduction in UPCR at 12 months (from either diagnosis or 6-months) was strongly associated with a lower risk of kidney failure (p0.002). […] We demonstrate that proteinuria a short time after diagnosis is a strong predictor of long-term outcomes and that a UPCR 0.88g/g (100mg/mol) at 1 year is associated with a substantially lower kidney failure risk. […] We provide quantitative descriptions of the relationships between early changes in both eGFR and proteinuria, and long-term renal outcomes.
#34 Clinical Predictors of Long-term Outcomes in C3 Glomerulopathy and Immune-Complex Membranoproliferative Glomerulonephritis within the UK RaDaR Registry | medRxiv
https://www.medrxiv.org/content/10.1101/2024.02.03.24301605v1.full-text
85/135 (63%) C3G and 107/152 (70%) IC-MPGN patients reached kidney failure over follow-up after a median of 9.7 years (95% CI 7.6-12.4). […] Kidney survival was strongly associated with eGFR at baseline and 12-month timepoints (p0.001). […] In contrast, both a time averaged 0.44g/g (50mg/mmol) and 50% reduction in UPCR at 12 months (from either diagnosis or 6-months) was strongly associated with a lower risk of kidney failure (p0.002). […] We demonstrate that proteinuria a short time after diagnosis is a strong predictor of long-term outcomes and that a UPCR 0.88g/g (100mg/mol) at 1 year is associated with a substantially lower kidney failure risk. […] We provide quantitative descriptions of the relationships between early changes in both eGFR and proteinuria, and long-term renal outcomes.
#35 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Current research in the field focuses on identification of clinical, histological and molecular markers of activity, damage, treatment response and renal prognosis. […] By contrast, early decrease of proteinuria levels over 6months of treatment has shown ability to predict a more favourable long-term renal outcome compared with patients with persistently high-grade proteinuria. […] Nevertheless, while this clinical target could identify patients who had a good renal outcome with a high positive predictive value, it could not predict the outcome of patients who did not achieve the target since the negative predictive value of this proteinuria cut-off was low in two of the three investigations. […] The role of the repeat kidney biopsy in patients with LN has been discussed rigorously during the last decades, but consensus among researchers and physicians has yet to be established.
#36 Glomerulonephritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560644/
Prognosis among the Nephritic Spectrum Diseases: PSGN has an excellent prognosis, especially in children with complete recovery, usually occurring within 6 to 8 weeks. In adults, around 50% of the patients continue to have reduced renal function, hypertension, or persistent proteinuria. Frequently IgA nephropathy has a benign course. Others gradually progress to ESRD, with ESRD frequency increasing with age. Prognosis is predictable, to some extent, based on the Oxford classification. Additionally, on presentation, nephrotic range proteinuria, hypertension, high serum creatinine level, and widespread intestinal fibrosis of the kidneys indicate a poor prognosis. […] Henoch-Schnlein purpura is typically a self-limited illness that demonstrates an excellent prognosis in patients without renal involvement. The majority of patients fully recover in four weeks. The long-term morbidity of Henoch-Schnlein purpura depends on the extent of renal involvement. Approximately 1% of patients with Henoch-Schnlein purpura will develop ESRD and require renal transplantation.
#37 Bowmanâs capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications | Annals of the Rheumatic Diseases
https://ard.bmj.com/content/81/6/e95
Bowmans capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications. […] The present study demonstrates an improved performance of prognostic systems in predicting AAV outcome after the implementation of BCR, the additional predictive role of which can partly lie in the irreversible loss of nephrons consequent to the segmental glomerulosclerosis caused by BCR. […] Its addition to the model, which included only Berden’s class or ARRS, significantly improved the prognostic performance.
#38 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
The discrepant patterns between clinical and histological data at the time of the repeat kidney biopsy have prompted investigations on the role of the tissue-level information in tailoring treatment and portending the long-term kidney outcome. […] Altogether, accumulating evidence strongly supports the usefulness of repeat kidney biopsies as an integral part of treatment evaluation, including LN patients showing adequate clinical response. […] Hopefully, we will soon identify clinical, molecular or genetic markers, or combinations thereof, which reliably reflect renal histopathology and portend the long-term renal outcome.
#39 Routine cardiac biomarkers for the prediction of incident major adverse cardiac events in patients with glomerulonephritis: a real-world analysis using a global federated database | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03667-y
Glomerulonephritis (GN) is a leading cause of chronic kidney disease (CKD). Major adverse cardiovascular events (MACE) are prolific in CKD. The risk of MACE in GN cohorts is multifactorial. We investigated the prognostic significance of routine cardiac biomarkers, Troponin I and N-terminal pro-BNP (NT-proBNP) in predicting MACE within 5 years of GN diagnosis. […] In GN, routinely available cardiac biomarkers can predict incident MACE. The results suggest the clinical need for cardiovascular and mortality risk profiling in glomerular disease using a combination of clinical and laboratory variables. […] This analysis highlights that routine clinical laboratory cardiac biomarkers, frequently utilised in healthcare settings, can predict incident MACE in patients with GN. Across all GN and sub-groups of primary GN, a raised NT-proBNP and/or Troponin I produced a statistically significant correlation with incident MACE.
#40 Prediction of prognosis and renal outcome in lupus nephritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC7046967/
Current research in the field focuses on identification of clinical, histological and molecular markers of activity, damage, treatment response and renal prognosis. […] By contrast, early decrease of proteinuria levels over 6months of treatment has shown ability to predict a more favourable long-term renal outcome compared with patients with persistently high-grade proteinuria. […] Nevertheless, while this clinical target could identify patients who had a good renal outcome with a high positive predictive value, it could not predict the outcome of patients who did not achieve the target since the negative predictive value of this proteinuria cut-off was low in two of the three investigations. […] The role of the repeat kidney biopsy in patients with LN has been discussed rigorously during the last decades, but consensus among researchers and physicians has yet to be established.
#41 Outcome of fibrillary glomerulonephritis
https://smw.ch/index.php/smw/article/download/1469/1823?inline=1
FGN is a heterogeneous disease associated with significant risk of ESRD and mortality. […] The course of the disease may be influenced by the histological type of the glomerulonephritis and the time of therapy. […] The data presented confirms the poor prognosis of FGN. About one third of patients rapidly developed ESRD in a mean time of 8 months. […] FGN in the context of MGN seems to have a more favourable prognosis as compared to MES and MPGN and nephrotic range proteinuria is associated with poor outcome. […] None of the six patients, however, who were treated with immunosuppressive agents at a time when their kidney function was normal experienced ESRD over a mean follow up of 46 months, a finding that supports our hypothesis that early immunosuppressive treatment can improve the outcome and delay the decrease of kidney function. […] The success of immunosuppressive therapy may also depend on the type of glomerulonephritis seen by light microscopy. […] In conclusion: Fibrillary glomerulonephritis is a heterogeneous disease associated with significant risk of ESRD and mortality.