Management of idiopathic membranous nephropathy: evaluation of a standardized strategy in a Lorraine health network
Aubertin, P.; Ayav, C.; Stolz, A.; Kessler, M.èl.; Champigneulle, J.; Aymard, B.; Frimat, L.
Nephrologie and Therapeutique 11(1): 16-26
2015
ISSN/ISBN: 1872-9177 PMID: 25547809 DOI: 10.1016/j.nephro.2014.09.004Document Number: 283231
The evolution of idiopathic membranous membranous (MNi) is variable, treatment is discussed. Our work's main objective was to evaluate the results of a standardized management strategy proposed in 2006 in Lorraine (Nephrolor health network). The secondary objective was to evaluate the professional practices. This study compared the evolution of incident MNi between 2002 and 2005 (Before) and between 2007 and 2010 (After), the respective dates point to 31/12/2011 and 31/12/2006. In nephrotics patients without renal failure, the risk assessment of end stage renal disease based on urinary β2-microglobulin (uβ2 m, threshold to 0,5 μg/min). Patients at high risk should receive immunosuppressive therapy (IS). Seventy-four biopsy-proven MNi were diagnosed with 50 nephrotic (22 Before and 28 After) of which 20 had normal renal function. In these nephrotic, there was no significant difference in the probability and the average time of remission between the two groups (P=0.26). Dosage of uβ2m was performed in 35% of cases. Fifty percent were treated with IS respecting strategy. Despite differences between the strategy and practices, which may explain these non-significant results, we observed changes in thinking and therapeutic attitude of the clinician. The implementation of this strategy tends to standardize and improve practices about MNi in Lorraine, which seems to improve results in remission. We encourage to generalize the application of this strategy and to continue this cohort follow.
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