Abstract
BackgroundImmunosuppressive treatment will predispose an idiopathic membranous nephropathy (iMN) patient to opportunistic infections. Disease severity is one of the main concerns for making the treatment decision. Urinary angiotensinogen (UAGT) level has been shown highly correlated with intrarenal renin-angiotensin system (RAS) activity and severity of chronic kidney diseases (CKD). We aimed to test the relationship between the UAGT level and the severity of iMN.MethodsThis cross-sectional study included a total of 48 biopsy-proven iMN patients, 46 minimal change disease (MCD) patients, and 44 healthy volunteers. The clinical and laboratory data and urine samples were collected from all subjects before the use of RAS inhibitors. We determined the UAGT levels with a method of enzyme-linked immunosorbent assay.ResultsThe UAGT levels were not different between the iMN (277.05 ± 61.25, μg/g.Cr) and MCD patients (244.19 ± 40.24, μg/g.Cr), but both of them were significantly higher than those of healthy controls (6.85 ± 1.10, μg/g.Cr). UAGT levels were correlated negatively with serum albumin (r = − 0.393, p = 0.006) and estimated glomerular filtration rate (eGFR) (r = − 0.352, p = 0.014) and positively with 24-h proteinuria (r = 0.614, p < 0.001) in iMN patients but not in MCD patients. Multivariate linear regression analysis revealed that only proteinuria independently determinate the levels of UAGT (β = 0.649, p < 0.001) in iMN patients.ConclusionsUAGT levels were correlated negatively with serum albumin and glomerular filtration rate and positively with proteinuria in iMN patients at the onset. This suggests that elevated levels of UAGT are associated with the severity of iMN. The UAGT level may be used as a cofactor for deciding immunosuppressive therapy in iMN patient.
Highlights
Immunosuppressive treatment will predispose an idiopathic membranous nephropathy patient to opportunistic infections
A total of 48 idiopathic membranous nephropathy (iMN) patients, 46 minimal change disease (MCD) patients, and 44 healthy volunteers were included in this study
The levels of blood pressure, estimated glomerular filtration rate (eGFR), serum albumin and proteinuria were different among groups
Summary
Immunosuppressive treatment will predispose an idiopathic membranous nephropathy (iMN) patient to opportunistic infections. Urinary angiotensinogen (UAGT) level has been shown highly correlated with intrarenal renin-angiotensin system (RAS) activity and severity of chronic kidney diseases (CKD). We aimed to test the relationship between the UAGT level and the severity of iMN. Idiopathic membranous nephropathy (iMN) is a common cause of adult-onset nephrotic syndrome and increased by more than twice over the past decade in China [1]. Most iMN patients maintained renal function for prolonged periods and likely to have spontaneous remission (SR). It is of interest to many researchers to distinguish these high-risk iMN patients. Cattran group created the Toronto Risk Score which accurately predicted the progression of iMN and was based on the change in creatinine clearance and the maximum of proteinuria during a 6-month period [5]. Several urinary markers have been proposed to predict progression in iMN [6, 7], especially low-molecular-weight proteins including α1 and β2 microglobulins [2]
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