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Publications

Journal Article Epublish

PubMed: 42494786 DOI: 10.1016/j.ekir.2026.106678

Outcomes and Predictors of Treatment Response in Patients With Pure Lupus Membranous Nephropathy.

Kidney Int Rep 11(9):106678

Authors: Kevin Chevalier, Romain Brousse, Alexandre Karras, Nathalie Costedoat-Chalumeau, Julien Dang, Maxence Tailliar, Noémie Jourde-Chiche, Charles Ronsin, Moglie Le Quintrec-Donnette, Marie Julien, Stanislas Faguer, Aymeric Couturier, Pierre Pommerolle, Céline Lebas, Antoine Coussement, Marion Chapal, Christophe Barba, Alexia Gauffre, Maxime Teisseyre, Johan Noble, Chloé Comarmond, Eve Vilaine, Jean-François Augusto, Aurélie Hummel, Évangéline Pillebout, Jean-Michel Halimi, Olivier Moranne, Eric Daugas, Jean-Jacques Boffa, Emmanuel Esteve

Affiliations

  • Department of Nephrology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Institut national de la santé et de la recherche médicale (INSERM) CORAKID U155, Sorbonne University, Paris, France.
  • Department of Nephrology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
  • Department of Internal Medicine, Reference Center for Rare Systemic Auto Immune and Autoinflammatory Diseases of Ile de France East and West, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
  • Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Le Kremlin-Bicêtre, France.
  • Department of Nephrology and Renal Transplantation, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
  • Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France.
  • Department of Nephrology, Intensive Care, Dialysis, and Transplantation, Hôpital Lapeyronie, Montpellier, France.
  • Nephrology Department, CHU de la Réunion, Saint Denis, France.
  • Département de Néphrologie et Transplantation d'Organes, Axe Transplantation - Immunité - Environnement, CHU de Toulouse, France.
  • Nephrology Unit, American Hospital of Paris, Neuilly-sur-Seine, France.
  • Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France.
  • Department of Nephrology and Renal Transplantation, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
  • Department of Nephrology, CHU de Dijon, Dijon, France.
  • Department of Nephrology, Hospital of Vendée, La Roche-Sur-Yon, France.
  • Department of Nephrology and Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre- Bénite, France.
  • Department of Nephrology, CHU de Rouen, Rouen, France.
  • Département de Néphrologie, Dialyse et Transplantation, CHU de Nice, Université Côte d'Azur, France.
  • Department of Nephrology, Grenoble-Alpes University Hospital, Grenoble, France.
  • Internal Medicine Department, Département Médico-Universitaire INVICTUS, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Nord-Université Paris-Cité, Paris, France.
  • Department of Nephrology - Hemodialysis, CHU Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Versailles-Saint Quentin-en-Yvelines, Boulogne-Billancourt, France.
  • Department of Nephrology-Dialysis-Transplantation, Université d'Angers, CHU Angers, Angers, France.
  • Department of Nephrology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Department of Nephrology, Saint Louis Hospital, Paris, France.
  • Department of Nephrology, UMR1327 Ischemia, Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists (INI-CRCT), Tours University Hospital, Tours University, Tours, France.
  • Department of Nephrology, Dialysis and Apheresis, CHU de Nîmes, IDESP Universite de Montpellier, France.
  • Nephrology Department, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Université Paris Cité and INSERM U1149, Paris, France.

Abstract

INTRODUCTION

The indications and modalities of therapeutic strategies for first-onset pure lupus membranous nephropathy (PLMN) remain poorly defined. We aimed to evaluate renal response rates across real-world treatment strategies and identify predictors of treatment response in PLMN.

METHODS

We conducted a multicenter retrospective study in 25 French centers. Patients with biopsy-proven first-onset PLMN treated between 2000 and 2020 were included. Patients were classified according to their initial treatment strategy. Renal response rates were defined based on the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Factors associated with treatment failure at 12 months were assessed using logistic regression.

RESULTS

Among 194 patients with PLMN, 53 (27.3%) received supportive care only, and 141 (72.7%) received immunosuppressive therapy (54 [38.3%] received mycophenolate mofetil (MMF)-based regimens, 26 [18.4%] received rituximab [RTX]-based regimens, and 61 [43.3%] received other treatments). At 12 months, rates of complete renal response (CRR) and CRR or partial renal (PRR) were respectively, 36.7% and 55.1% with supportive care, 47.1% and 60.8% with MMF, 64.0% and 72.0% with RTX, and 45.4% and 54.5% with other regimens. In multivariable analysis, the presence of anti-U1-ribonucleoprotein (U1RNP) antibodies was independently associated with treatment failure (adjusted odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.35-4.70; P = 0.004), whereas extrarenal lupus involvement was protective (adjusted OR = 0.39; 95% CI: 0.19-0.73; P = 0.004). RTX-based regimens were significantly associated with shorter treatment duration and corticosteroid sparing.

CONCLUSION

In patients with first-onset PLMN, 12-month renal response rates did not differ significantly among immunosuppressive regimens despite variation in treatment duration and steroid exposure. Anti-U1RNP antibodies and absence of extrarenal involvement were associated with a higher risk of treatment failure. Anti-CD20-based strategies may be a promising therapeutic approach.

MeSH

Glomerulonephritis, Membranous, Antibodies, Duration Of Therapy, Treatment Failure, Lupus Erythematosus, Systemic, Rituximab, Therapeutics, Steroids, Mycophenolic Acid