Title

Treatment Patterns Among Adults and Children With Membranous Nephropathy in the Cure Glomerulonephropathy Network (CureGN).

Creator(s)

Michelle M. O'Shaughnessy
Jonathan P. Troost
Andrew S. Bomback
Michelle A. Hladunewich
Isa F. Ashoor
Keisha L. Gibson
Raed Bou Matar
David T. Selewski
Tarak Srivastava, Children's Mercy HospitalFollow
Michelle N. Rheault
Amira Al-Uzri
Amy J. Kogon
Myda Khalid
Suzanne Vento
Neil S. Sanghani
Brenda W. Gillespie
Debbie S. Gipson
Chia-Shi Wang
Afshin Parsa
Lisa Guay-Woodford
Louis-Philippe Laurin

Document Type

Article

Publication Date

9-16-2019

Identifier

DOI: 10.1016/j.ekir.2019.09.005; PMCID: PMC6895579

Abstract

Introduction: The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for Glomerulonephritis recommend that patients with membranous nephropathy (MN) at risk for progression receive immunosuppressive therapy (IST), usually after 6 months of observation. A cyclophosphamide (CYC) or calcineurin inhibitor (CNI)-based regimen is recommended as first-line IST. However, the extent to which KDIGO recommendations are adopted in practice remains largely unknown.

Methods: We evaluated prescribing practice among patients with primary MN (diagnosed 2010-2018) enrolled in the Cure Glomerulonephropathy Network (CureGN) cohort study. We also evaluated the availability of testing for phospholipase A2 receptor (PLA2R) in the contemporary era.

Results: Among 361 patients (324 adults and 37 children) with MN who were IST-naïve at biopsy and had at least 6 months of follow-up, 55% of adults and 58% of children initiated IST <6 months after biopsy. Of these, 1 in 5 had no indication for (i.e., urine protein-to-creatinine ratio [uPCR] < 4 g/g) or an apparent contraindication to (i.e., an estimated glomerular filtration rate [eGFR] <30 ml/min per 1.73 m2) IST. As first-line IST, half of treated patients received either CYC (16% of adults; 0% of children) or a CNI (40% and 46%, respectively), whereas 1 in 5 received corticosteroid monotherapy (20% and 27%, respectively) and 1 in 6 rituximab (15% and 15%, respectively). More than 80% of surveyed centers had access to PLA2R testing.

Conclusion: These findings suggest that providers are not aware of, or lack confidence in, current KDIGO guidelines for MN. Treatment patterns observed in this cohort might critically inform the drafting of planned updates to KDIGO guidelines.

Journal Title

Kidney Int Rep

Volume

4

Issue

12

First Page

1725

Last Page

1734

Keywords

immunosuppression; membranous nephropathy; treatment patterns

Comments

Grant support

• U54 GM104940/GM/NIGMS NIH HHS/United States
• UL1 TR002548/TR/NCATS NIH HHS/United States

This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Recommended Citation

O'Shaughnessy, M. M., Troost, J. P., Bomback, A. S., Hladunewich, M. A., Ashoor, I. F., Gibson, K. L., Matar, R., Selewski, D. T., Srivastava, T., Rheault, M. N., Al-Uzri, A., Kogon, A. J., Khalid, M., Vento, S., Sanghani, N. S., Gillespie, B. W., Gipson, D. S., Wang, C., Parsa, A., Guay-Woodford, L., Laurin, L. Treatment Patterns Among Adults and Children With Membranous Nephropathy in the Cure Glomerulonephropathy Network (CureGN). Kidney Int Rep 4, 1725-1734 (2019).