Skip to main content
SpringerLink
Log in

Lupus-like membranous nephropathy: Is it lupus or not?

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Membranous glomerulonephritis is typically classified as idiopathic or secondary to systemic lupus erythematosus (SLE), hepatitis B, drugs, toxins, other infections, or malignancy. Not infrequently in some patients without a definite diagnosis of SLE, pathologic features of secondary membranous nephropathy are seen e.g., mesangial and/or subendothelial deposits, tubuloreticular inclusions, and full house immunofluorescence. In these patients, there is uncertainty about the etiology, response to therapy, and prognosis of membranous GN.

Methods

We retrospectively reviewed the charts of 98 patients with membranous GN at San Francisco General Hospital and John Stroger Hospital of Cook County over a 10-year period. Data were collected and analyzed using SPSS.18.

Results

Thirty-nine (40 %) had idiopathic membranous GN (Group 1), thirty-six (37 %) had lupus membranous GN (Group 2) and twenty-three (23 %) had some pathological features of secondary membranous GN, but no definite etiology of membranous GN (Group 3). At baseline (at time of renal biopsy) and after mean follow-up of 3.5 years, the average serum creatinine (in mg/dL) in Group 1 was (1.6 ± 1.0 versus 1.6 ± 1.7), Group 2 was (1.8 ± 2.5 versus 1.2 ± 0.9) and Group 3 was (1.1 ± 0.4 versus 1.27 ± 0.83), respectively. For the same time points, the average urine protein to creatinine ratio (g/g) in Group 1 was (9.8 ± 7.1 versus 5.7 ± 6.7), Group 2 was (4.2 ± 3.9 versus 1.7 ± 2.2), and Group 3 was (7.4 ± 5.7 versus 3.1 ± 3.8). In addition, during the follow-up period, eleven of 39 (28 %) in Group 1, two of 36 (6 %) in Group 2, and three of 23 (13 %) in Group 3 progressed to end-stage renal disease and were started on dialysis.

Conclusions

It appears that patients with lupus membranous GN have better renal prognosis than patients with idiopathic membranous GN. The renal prognosis for patients with pathological features of lupus membranous but no diagnosis of systemic lupus (lupus-like membranous GN) falls in between. Further studies are needed to determine if Group 3 patients can (a) definitively be classified as true idiopathic membranous GN or lupus membranous GN or (b) they have a separate disease from either M-type phospholipase A2 receptor membranous nephropathy or systemic lupus-induced membranous nephropathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Simenhoff ML, Merrill JP. The spectrum of lupus nephritis. Nephron. 1964;1:348–74.

    Article  CAS  PubMed  Google Scholar 

  2. Libit SA, Burke B, Michael AF, Vernier RL. Extramembranous glomerulonephritis in childhood: relationship to systemic lupus erythematosus. J Pediatr. 1976;88(3):394–402.

    Article  CAS  PubMed  Google Scholar 

  3. Bihari M, Kallen RJ, Spango BH. The course of membranus nephropathy in childhood, Fifth International Congress of Nephrology, Mexico City, 1972 (Abst.).

  4. Kallen RJ, Lee SK, Aronson AJ, Spargo BH. Idiopathic membranous glomerulopathy preceding the emergence of systemic lupus erythematosus in two children. J Pedriatr. 1977;90(1):72–6.

    Article  CAS  Google Scholar 

  5. Cairns SA, Corbett CL, Lawler W, Mallick NP, Acheson EJ, Dosa S, Williams G. The delayed appearance of an antinuclear factor and the diagnosis of systemic lupus erythematosus in glomerulonephritis. Postgrad Med J. 1979;55:723–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Shearn MA, Hopper J, Biava CG. Membranous lupus nephropathy initially seen as idiopathic membranous nephropathy. Arch Intern Med. 1980;140:1521–3.

    Article  CAS  PubMed  Google Scholar 

  7. Adu D, Williams DG, Taube D, Vilches AR, Turner DR, Cameron JS, Ogg CS. Late onset systemic lupus erythematosus and lupus-like disease in patients with apparent idiopathic glomerulonephritis. Q J Med. 1983;208:471–87.

    Google Scholar 

  8. Wen YK, Chen ML. Clinicopathological study of originally non-lupus “full-house” nephropathy. Ren Fail. 2010;32(9):1025–30.

    Article  PubMed  Google Scholar 

  9. Jeannette JC, Iskandar SS, Dalldorf FG. Pathologic differentiation between lupus and nonlupus membranous glomerulopathy. Kidney Int. 1983;24:377–85.

    Article  Google Scholar 

  10. Gianviti A, Barsotti P, Barbera V, Faraggiana T, Rizzoni G. Delayed onset of systemic lupus erythematosus in patients with “full-house” nephropathy. Pediatr Nephrol. 1999;13:683–7.

    Article  CAS  PubMed  Google Scholar 

  11. Yang AH, Lin BS, Kuo KL, Chang CC, Ng YY, Yang WC. The clinicopathological implications of endothelial tubuloreticular inclusions found in glomeruli having histopathology of idiopathic membranous nephropathy. Nephrol Dial Transplant. 2009;24:3419–25.

    Article  PubMed  Google Scholar 

  12. Ehrenreich T, Porush JG, Churg J, et al. Treatment of idiopathic membranous nephropathy. N Engl J Med. 1976;295:741–6.

    Article  CAS  PubMed  Google Scholar 

  13. Zeng CH, Chen HM, Wang RS, Chen Y, Zhang SH, Liu L, Li LS, Liu ZH. Etiology and clinical characteristics of membranous nephropathy in chinese patients. Am J Kidney Dis. 2008;52(4):691–8.

    Article  PubMed  Google Scholar 

  14. Abe S, Amagasaki Y, Konishi K, et al. Idiopathic membranous glomerulonephritis: aspects of geographical differences. J Clin Pathol. 1986;39:1193–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Cahen R, Francois B, Trolliet P, et al. Etiology of membranous glomerulonephritis: a prospective study of 82 adult patients. Nephrol Dial Transplant. 1989;4:172–80.

    CAS  PubMed  Google Scholar 

  16. Honkanen E. Survival in idiopathic membranous glomerulonephritis. Clin Nephrol. 1986;25:122–8.

    CAS  PubMed  Google Scholar 

  17. Southwest pediatric nephrology study group. Comparison of idiopathic and systemic lupus erythematosus-associated membranous glomerulopathy in children. Am J Kidney Dis. 1986;7(2):115–24.

    Article  Google Scholar 

  18. Haas M. IgG subclass deposits in glomeruli of lupus and nonlupus membranous nephropathies. Am J Kidney Dis. 1994;23(3):358–64.

    Article  CAS  PubMed  Google Scholar 

  19. Ng YY, Yang WC, Yang AH. Frequency of secondary versus idiopathic membranous nephropathy. Am J Kidney Dis. 2009;53(4):719–20 (Letter).

    Article  PubMed  Google Scholar 

  20. St. John TM. Chronic hepatitis B and C in China. Hepatitis Magazine. Spring 2002.

  21. Burstein DM, Korbet SM, Schwartz MM. Membranous glomerulonephritis and malignancy. Am J Kidney Dis. 1993;22(1):5–10.

    Article  CAS  PubMed  Google Scholar 

  22. Doi T, Mayumi M, Kanatsu K, Suehiro F, Hamashima Y. Distribution of IgG subclasses in membranous nephropathy. Clin Exp Immunol. 1984;58:57–62.

    CAS  PubMed Central  PubMed  Google Scholar 

  23. Ohtani H, Wakui H, Komatsuda A, Okuyama S, Masai R, Maki N, Kigawa A, Sawada KI, Imai H. Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy. Nephrol Dial Transplant. 2004;19:574–9.

    Article  CAS  PubMed  Google Scholar 

  24. Ponticelli C, Zucchelli P, Passerini P, Cagnoli L, Cesana B, Pozzi C, Pasquali S, Imbasciati E, Grassi C, Redaelli B, Sasdelli M, Locatelli F. A randomized trial of methylprednisolone and chlorambucil in idiopathic membranous nephropathy. N Engl J Med. 1989;320:8–13.

    Article  CAS  PubMed  Google Scholar 

  25. Guasch A, Suranyi M, Newton L, Hall BM, Myers BD. Short-term responsiveness of membranous glomerulopathy to cyclosporine. Am J Kidney Dis. 1992;20(5):472–81.

    Article  CAS  PubMed  Google Scholar 

  26. Cattran DC, Appel GB, Hebert LA, Hunsicker LG, Pohl MA, Hoy WE, Maxwell DR, Kunis CL, North America Nephrotic Syndrome Study Group. Cyclosporine in patients with steroid-resistant membranous nephropathy: a randomized trial. Kidney Int. 2001;59(4):1484–90.

    Article  CAS  PubMed  Google Scholar 

  27. Yao X, Chen H, Wang Q, Tang Z, Hu W, Yin G, Liu Z, Li L. Cyclosporin A treatment for idiopathic membranous nephropathy. Chin Med J. 2001;114(12):1305–8.

    CAS  PubMed  Google Scholar 

  28. Alexopoulos E, Papagianni A, Tsamelashvili M, Leontsini M, Memmos D. Induction and long-term treatment with cyclosporine in membranous nephropathy with the nephrotic syndrome. Nephrol Dial Transplant. 2006;21(11):3127–32.

    Article  CAS  PubMed  Google Scholar 

  29. Goumenos DS, Datopodis KP, Passadakis P, Vardaki E, Liakopoulos V, Dafnis E, Stefanidis I, Vargemezis V, Vlachojannis JG, Siamopoulos KC. Corticosteroids and ciclosporin A in idiopathic membranous nephropathy: higher remission rates of nephrotic syndrome and less adverse reactions than after traditional treatment with cytotoxic drugs. Am J Nephrol. 2007;27(3):226–31.

    Article  CAS  PubMed  Google Scholar 

  30. Donadio JV, Burgess JH, Holley KE. Membranous lupus nephropathy: a clinicopathologic study. Medicine. 1977;56(6):527–36.

    Article  PubMed  Google Scholar 

  31. Sloan RP, Schwartz MM, Korbet SM, Borok RZ, Lupus Collaborative Study Group. Long-term outcome in systemic lupus erythematosus membranous glomerulonephritis. J Am Soc Nephrol. 1996;7:299–305.

    CAS  PubMed  Google Scholar 

  32. Sun HO, Hu WX, Xie HL, Zhang HT, Chen HP, Zeng CH, Liu ZH, Li LS. Long-term outcome of Chinese patients with membranous nephropathy. Lupus. 2008;17:56–61.

    Article  CAS  PubMed  Google Scholar 

  33. Mok CC, Ying KY, Yim CW, Ng WL, Wong WS. Very long-term outcome of pure lupus membranous nephropathy treated with glucocorticoid and azathioprine. Lupus. 2009;18:1091–5.

    Article  CAS  PubMed  Google Scholar 

  34. Beck LH, Bonegio RGB, Lambeau G, Beck DM, Powell DW, Cummins TD, Klein JB, Salant DJ. M-Type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361(1):11–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interests in this manuscript.

Author information

Authors and Affiliations

  1. Division of Nephrology, San Francisco General Hospital and the University of California, 1001 Potrero Ave, Building 100, Rm 342, San Francisco, CA, 94110-1341, USA

    Ramin Sam & Sam James

  2. Division of Nephrology, Stroger Hospital of Cook County, Chicago, IL, USA

    Amit Joshi & Peter Hart

  3. Department of Pathology, University of California, San Francisco, CA, USA

    Kuang-Yu Jen

  4. Department of Biostatistics, Ardabil University of Medical Sciences, Ardabil, Iran

    Firouz Amani

  5. Department of Pathology, Rush Medical College, Chicago, IL, USA

    Melvin M. Schwartz

Authors
  1. Ramin Sam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Joshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sam James
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuang-Yu Jen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Firouz Amani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Melvin M. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ramin Sam.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sam, R., Joshi, A., James, S. et al. Lupus-like membranous nephropathy: Is it lupus or not?. Clin Exp Nephrol 19, 395–402 (2015). https://doi.org/10.1007/s10157-014-1002-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-014-1002-1

Keywords

Search

Navigation