Pathologic findings of initial biopsies reflect the outcomes of membranous nephropathy

Background. A considerable diversity of prognosis is seen with idiopathic membranous nephropathy (IMN). The initial factors affecting long-term outcome remain unclear. Methods. We studied retrospectively 105 patients with IMN who had been followed up for at least 5 years, or until end-stage renal failure (ESRF) (primary outcome), or death (secondary outcome). We analyzed the initial clinicopathologic factors affecting primary and secondary outcomes. We assigned the patients to two groups and one subgroup, based on the electron microscopic findings. The groupings were: homogeneous type with synchronous electron dense deposits; homogeneous type with large dense deposits (deep subgroup); and heterogeneous type with various phases of dense deposits. Results. No differences in the initial clinicopathologic states were seen between the homogeneous (N = 60) and heterogeneous types (N = 45), apart from hypertension and disease history before biopsy. In the homogeneous type, only one patient developed ESRF, which was drug-induced, and remission occurred earlier than in the heterogeneous type. With regard to secondary outcomes, increased age, male gender, heterogeneous type, and deep subgroup were independent risk factors. There were no significant differences attributable to therapeutic regime with respect to primary or secondary outcome in either group. Conclusion. Our results indicate that an electron microscopic classification, at initial biopsy, as heterogeneous type or deep subgroup type with dense deposits are independent indicators of poor prognosis in IMN.