Abstract
BackgroundTertiary lymphoid organs play an essential role in the inflammation of the kidney. The clinical association between TLOs and membranous nephropathy (MN) is not clear yet.MethodsConsecutive patients with the histologically confirmed membranous nephropathy in Tongji Hospital from July 19, 2012, to September 26, 2019, were included in this study. TLOs in renal biopsy tissues were detected by periodic acid–Schiff-stained and immunohistochemistry. Logistic regression was performed to evaluate the correlations of TLOs and clinical features of patients with MN. Kaplan–Meier analysis was utilized to examine the relationship between TLOs and remission of proteinuria.ResultsA total of 442 patients with MN were included in this study, of which the average age was 46.4 years old, and 58.8% were male. Moreover, 33% of patients with MN had TLOs in this study. The median value of proteinuria among patients with MN with TLOs was 4.9 g/24 h, which was much greater than no-TLOs ones (3.2 g/24 h, p < 0.001). Moreover, the patients with TLOs had higher serum creatinine and lower serum albumin. The severity of clinical features among the patients with MN aggravated with the increase in the grade of TLOs. In addition, the patients who had TLOs were more likely to be positive of anti-phospholipase A2 receptor autoantibodies. Meanwhile, the patients without TLOs showed significantly higher complete remission and total remission of proteinuria.ConclusionIn this study, we demonstrated that TLOs were common among patients with MN. Moreover, the patients with MN with TLOs showed a worse clinical manifestation and an outcome compared with the patients without TLOs.
Highlights
Membranous nephropathy is the most common cause of adult nephrotic syndrome worldwide, representing 20–37% of cases in most series, rising up to 40% in ages over 60 years [1]
Our study revealed that the patients with membranous nephropathy (MN) with renal TLOs had greater proteinuria, higher Scr, and a lower remission rate of proteinuria
The presence of renal TLOs indicated poor renal condition, which is in agreement with previous studies
Summary
Membranous nephropathy is the most common cause of adult nephrotic syndrome worldwide, representing 20–37% of cases in most series, rising up to 40% in ages over 60 years [1]. It is reported that two-thirds of the patients with MN will experience persistent proteinuria or progress to end-stage renal disease (ESRD) over 10 years [3], and the remaining third will get a spontaneous remission without any remedies [4]. Early and accurate prediction of prognosis in patients with MN is critical. It is of significance to defining specific pathological features associated with prognosis and disease severity of MN, as optical microscopy and immunohistochemistry can be assessed in clinical everyday practice. The clinical association between TLOs and membranous nephropathy (MN) is not clear yet
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