S KUO1, L JEFFS1,M JOSE1,2, G KIRKLAND1, R YU1, S YEW1
1Royal Hobart Hospital, Hobart, Australia, 2School of Medicine, University of Tasmania, Hobart, Australia
Aim: To describe the incidence, management and outcome of idiopathic membranous nephropathy in Southern Tasmania.
Background: Membranous nephropathy accounts for 20-30% of nephrotic syndrome. Though there is increasing understanding, data in the Tasmanian population remains unknown.
Methods: A retrospective study was performed on patients (>18 years) who had biopsy diagnosed membranous nephropathy in 2007-2017 in Southern Tasmania.
Results: 27 patients (male 71%, median age 58yrs, interquartile range [IQR] 18) were diagnosed with idiopathic membranous nephropathy and 24 have clinical details available.
At diagnosis, the median blood pressure was 145/83mmHg (IQR13/15) with median estimated glomerular filtration rate (eGFR) 50mls/min/1.73m2 (IQR33), albumin creatinine ratio (ACR) 413 g/mol creat (IQR 674), 24-hour urine protein 5.5g/day (IQR4.2) and albumin 26g/L (IQR15). 16 were tested for antibodies to phospholipase A2 receptor and 10 were positive.All patients were commenced on angiotensin inhibition antihypertensive. 10 (42%) were immunosuppressed with alkylating agents, 7 within six months of diagnosis due to severe nephrotic syndrome, delay between symptom onset and biopsy, or severe thrombotic complications. Remission was not achieved in 4 and Rituximab induction was given.20 patients had 1-year follow up with median eGFR of 44 (IQR26) and ACR 115 (IQR190).To date, the median follow-up time is 51months (IQR35). 15 (75%) remains in remission with median eGFR 60 (IQR41) and ACR 22 (IQR92). 8(53%) of those received alkylating agents. One died from unrelated cause, one yet to achieve remission, two relapsed and one progressed to renal failure.
Conclusions: The incidence and long term prognosis of membranous nephropathy in southern Tasmania is comparable to that of international reports.
Renal registrar at Royal Hobart Hospital