Efficacy of immunosuppressive therapy in low-risk and intermediate- risk idiopathic membranous nephropathy patients

Background The efficacy and safety of immunosuppressive therapy for low- and intermediate-risk idiopathic membranous nephropathy remains unclear. Method 121 renal biopsy-confirmed idiopathic membranous nephropathy (IMN) patients were retrospectively included from the Department of Nephrology in the First Affiliated Hospital of USTC from 2021 to 2023. Participants were stratified by baseline urinary protein-to-creatinine ratio (PCR) (low-risk group ≤ 3.0g/gCr v.s intermediate-risk group > 3.0g/gCr) and received immunosuppressive therapy at initial treatment. During a 12-month follow-up, proteinuria remission rates at 6 month and 12 month were compared between the two groups, and concurrently documented infectious events. Binary logistic regression analyze was conducted to identify the risk factors for proteinuria remission. Results During a 6-month follow-up, complete proteinuria remission rates in low-risk group was significantly higher than intermediate-risk group (62.1% v.s 41.8%, P  = 0.03), but there were no significant difference on total proteinuria remission rates between low-risk group and intermediate-risk group (80.3% v.s 74.5%, P  = 0.51). Binary logistic regression analyze showed that baseline serum albumin ( OR  = 1.17, 95% CI :1.06–1.29, P  < 0.01), glycemic abnormality ( OR  = 0.32, 95% CI :0.12–0.86, P  = 0.02), intermediate-risk group ( OR  = 0.41, 95% CI : 0.19–0.99, P  = 0.04), and hemoglobin as independent predictors for complete proteinuria remission at 6 month. During 12 months, total proteinuria remission rate (83.3% v.s 91.3%, P  = 0.36) and complete proteinuria remission rate (75.0% v.s 65.2%, P  = 0.29) had no significant difference between the two groups. Overall infection incidence was 7.4% (9/121), with no difference between the two groups, and no mortality events observed. Conclusion Immunosuppressive therapy increased the total and complete proteinuria remission rates of patients in low-risk group without increasing the risk of infection.