How to predict the progress of Membranous Nephropathy to ESKD?
Finding useful markers that predict this group is difficult. The best model for identifying patients at risk was developed from the Toronto Glomerulonephritis Registry.
This model takes into consideration the initial creatinine clearance (CrCl), the slope of the CrCl, and the lowest level of proteinuria during a 6-month observation period.
• Patients who present with a normal CrCl, proteinuria ≤4 g/24 hours, and stable kidney function over 6 months have an excellent long-term prognosis and are classified as low risk for progression.
• Patients with normal kidney function and whose CrCl remains unchanged during 6 months of observation but continue to have proteinuria >4 g but <8 g/24 hours have a 55% probability of developing CKD and are classified as medium risk for progression.
• Patients with persistent proteinuria >8 g/24 hours, independent of the degree of kidney dysfunction, have a 66% to 88% probability of progression to ESKD within 10 years and are classified as high risk of progression.
The discovery of anti-PLA 2 R autoantibodies and its potential role in the pathogenesis of the disease, its correlation with disease activity and long-term remission is changing the approach to patients with MN. Therefore anti-PLA 2 R positivity and antibody levels should be evaluated and taken into account when making decisions regarding treatment.