Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 16:13:e19331.
doi: 10.7717/peerj.19331. eCollection 2025.

Risk factors and predictive model for renal outcomes in autoimmune membranous nephropathy with and without acute kidney injury: a retrospective cohort study

Zhenzhou Li #  1   2   3 , Liyan Yang #  1   2   3 , Linxia Wei  1   2 , Mengjie Weng  1   2   3 , Jiaqun Lin  1   2   3 , Yi Chen  1   2   3 , Binbin Fu  1   2   3 , Guifen Li  1   2   3 , Caiming Chen  1   2   3 , Yanfang Xu  1   2   3 , Jianxin Wan  1   2   3 , Jiong Cui  1   2   3
Affiliations

Risk factors and predictive model for renal outcomes in autoimmune membranous nephropathy with and without acute kidney injury: a retrospective cohort study

Zhenzhou Li et al. PeerJ. .

Abstract

Objective: This study aimed to delineate the risk factors affecting renal outcomes in autoimmune membranous nephropathy (aMN) with or without acute kidney injury (AKI) and develop a predictive model.

Methods: This retrospective cohort study included 441 patients with biopsy-confirmed aMN from the First Affiliated Hospital of Fujian Medical University (January 2010 to March 2023). Patients were grouped based on the presence of AKI and followed up until a renal endpoint event (progression to end-stage renal disease, initiation of dialysis, or either a >40% decline in estimated glomerular filtration rate from baseline or a doubling of serum creatinine levels from baseline, both sustained for ≥3 months) or study endpoint (March 2024). Clinicopathological and renal outcomes were collected and analyzed. Risk factors for renal endpoints were identified via Cox regression analyses, and a nomogram was constructed. Model performance was evaluated using the C-index, time-dependent receiver operating characteristic (Time-ROC) curves, calibration curves, and decision curve analysis (DCA). Kaplan-Meier survival curves compared renal survival between AKI subgroups.

Results: Among 441 patients, 109 (24.72%) experienced AKI. Renal endpoint events occurred in 40.4% of the AKI group and 4.5% of the non-AKI group. Multivariate Cox regression identified AKI (HR = 7.298, P < 0.001), triglycerides (HR = 1.140, P = 0.002), serum creatinine (HR = 1.008, P = 0.012), hematuria (HR = 2.246, P = 0.040), and kidney anti-M-type phospholipase A2 receptor staining 4+ (HR = 2.473, P = 0.003) as independent risk factors, while serum C3 (HR = 0.082, P < 0.001) was an independent protective factor. The nomogram had a C-index of 0.845 (P < 0.001), with Time-ROC AUCs of 0.92, 0.81, 0.83, and 0.87 for 3 to 6 years, respectively. Calibration plots revealed good consistency between the predicted and actual probabilities. DCA indicated that the nomogram had potential clinical utility. Kaplan-Meier analysis showed lower cumulative renal survival in patients with AKI (P < 0.001).

Conclusions: The risk factor model suggests that renal outcomes in patients with aMN can be predicted. Early assessment and management targeting these identified risk factors could help delay renal function decline in these patients.

Keywords: Acute kidney injury; Autoimmune membranous nephropathy; Predictive model; Renal biopsy; Renal outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Study flowchart.
MN, membranous nephropathy; aMN, autoimmune membranous nephropathy; LN, lupus nephritis; HBV-GN, hepatitis B virus-associated glomerular nephritis; DN, diabetic nephropathy; AKl, acute kidney injury.
Figure 2
Figure 2. Prognostic nomogram for predicting renal endpoint events in patients with aMN over a 3–6-year period.
Figure 3
Figure 3. Time-dependent ROC curve and AUC for predicting renal endpoint events in patients with aMN over a 3–6-year period.
Figure 4
Figure 4. Calibration curves of the predictive model for renal survival in patients with aMN at different time points.
(A) 3 years. (B) 4 years. (C) 5 years. (D) 6 years.
Figure 5
Figure 5. Decision curve analysis of the predictive model for renal survival in patients with aMN at different time points.
(A) 3 years. (B) 4 years. (C) 5 years. (D) 6 years.
Figure 6
Figure 6. Kaplan–Meier renal survival plot for groups stratified by the presence of AKI.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Agrawal S, Zaritsky JJ, Fornoni A, Smoyer WE. Dyslipidaemia in nephrotic syndrome: mechanisms and treatment. Nature Reviews Nephrology. 2018;14:57–70. doi: 10.1038/nrneph.2017.155. - DOI - PMC - PubMed
    1. Austin HA, 3rd, Boumpas DT, Vaughan EM, Balow JE. Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney International. 1994;45(2):544–550. doi: 10.1038/ki.1994.70. - DOI - PubMed
    1. Avasare R, Andeen N, Beck L. Novel antigens and clinical updates in membranous nephropathy. Annual Review of Medicine. 2024;75:219–332. doi: 10.1146/annurev-med-050522-034537. - DOI - PubMed
    1. Bobart SA, De Vriese AS, Pawar AS, Zand L, Sethi S, Giesen C, Lieske JC, Fervenza FC. Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. Kidney International. 2019;95(2):429–438. doi: 10.1016/j.kint.2018.10.021. - DOI - PubMed
    1. Cattran DC, Brenchley PE. Membranous nephropathy: integrating basic science into improved clinical management. Kidney International. 2017;91(3):566–574. doi: 10.1016/j.kint.2016.09.048. - DOI - PubMed

LinkOut - more resources