Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy

TLDR

Spontaneous remission is a well‑known feature of idiopathic membranous nephropathy, yet contemporary studies on its predictors and long‑term outcomes are scarce. We performed a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome due to idiopathic membranous nephropathy who initially received conservative therapy. In this cohort, 32 % of patients achieved spontaneous remission (median 14.7 months), including those with massive proteinuria; remission was predicted by lower baseline proteinuria and creatinine, ACEi/ARB use, and a >50 % proteinuria decline in the first year, while relapse was rare (5.7 %) and death/ESRD rates were lower among remitters.

Abstract

Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 +/- 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission.