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Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up

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Abstract

Background

Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease.

Methods

We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed.

Results

Median (IQR) follow-up was 36 (24–60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08–0.79) when compared to rituximab (p < 0.05).

Conclusions

In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appears to be a winning strategy, and that the cyclic regimen also warrants a prominent role in primary membranous nephropathy treatment, since definitive proof of rituximab superiority is lacking.

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Data availability

Data cannot be shared for privacy reasons. The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The laboratory data, owned by the patients, comes from the company database of the laboratory of each Hospital involved. Data will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors thank Dr. Enrico Fabrizi, Professor of the Business and Economics Statistics at the Piacenza campus of the Università Cattolica del Sacro Cuore, Piacenza, Italy, for the support in statistical analysis of the data and drawing of the figures. All participating centers provided a comparable number of cases. We thank the study staff at all participating centers.

Funding

None.

Author information

Authors and Affiliations

  1. Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy

    Vittorio Albertazzi & Roberto Scarpioni

  2. Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy

    Francesco Fontana, Gabriele Donati & Gianni Cappelli

  3. Nephrology and Dialysis Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy

    Stefania Giberti & Mariacristina Gregorini

  4. Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy

    Valeria Aiello & Gaetano La Manna

  5. Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy

    Sara Battistoni & Angelo Rigotti

  6. Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy

    Fausta Catapano & Elena Mancini

  7. Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy

    Romina Graziani & Andrea Buscaroli

  8. Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy

    Simonetta Cimino & Decenzio Bonucchi

  9. Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy

    Laura Scichilone & Marcora Mandreoli

  10. Unit of Nephrology, University Hospital of Ferrara, Ferrara, Italy

    Silvia Forcellini & Alda Storari

  11. Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy

    Marco De Fabritiis & Giovanni Mosconi

  12. Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy

    Signorotti Sara & Giovanni Mosconi

  13. Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy

    Marco Delsante & Enrico Fiaccadori

Authors
  1. Vittorio Albertazzi
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  2. Francesco Fontana
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  3. Stefania Giberti
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  4. Valeria Aiello
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  5. Sara Battistoni
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  26. Roberto Scarpioni
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Consortia

for the Gruppo di Studio della Glomerulonefrite Membranosa in Emilia Romagna

Contributions

All authors were involved in conception and study design; Drs. Albertazzi, Fontana, Giberti, Aiello, Battistoni, Catapano, Graziani, Cimino, Schichilone, Forcellini, De Fabritiis, Signorotti, and Del Sante participated in data collection; Dr. Scarpioni and Dr. Albertazzi analyzed the data and drafted the manuscript. All authors revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Roberto Scarpioni.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local Ethical Committee of Area Vasta Nord of Emilia Romagna and all other local Ethics Committees in the region approved the study.

Informed consent

Written informed consent was obtained from all patients.

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Albertazzi, V., Fontana, F., Giberti, S. et al. Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up. J Nephrol 37, 471–482 (2024). https://doi.org/10.1007/s40620-023-01803-9

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  • DOI: https://doi.org/10.1007/s40620-023-01803-9

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