Factors associated with poor prognosis of Membranous Nephropathy
Several factors are associated with worse outcome in patients with MN including:
• Advanced age (>50)
• Male sex
• Elevated blood pressure
• CKD (low estimated glomerular filtration rat at presentation)
• Severity of initial proteinuria
• Persistent proteinuria
Persistent proteinuria of >4 g/24 hours is the strongest predictor of progressive kidney disease.
Histologic changes such as tubular atrophy, interstitial fibrosis, and glomerulosclerosis have also been associated with poor prognosis.
Elevated β 2 -microglobulin urinary excretion rate has been shown to predict poor outcome, but accurate measurement of urinary β 2 -microglobulin can be challenging.
Increasing evidence suggests that high anti-PLA 2 R autoantibody levels may be used in diagnosis and management of MN and to predict long-term outcomes.