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Renal survival in idiopathic membranous nephropathy: The impact of chronicity score and clinical predictors 

Hasan Kocaayan, Yusuf Uzum, Ibrahim Ertekin, Fulya Cakalagaoglu, and Zeki Soypacaci

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Volume 105 (2026) p. 195 - 201

Abstract

Clinical Nephrology, VVol. 105 – No. 3/2026 (195-201)

Renal survival in idiopathic membranous nephropathy: The impact of chronicity score and clinical predictors 

Hasan Kocaayan¹, Yusuf Uzum², Ibrahim Ertekin⁴, Fulya Cakalagaoglu³, and Zeki Soypacaci⁴

¹Division of Rheumatology, Department of Internal Medicine, School of Medicine, ²Ataturk Education Research Hospital Internal Medicine Clinic, ³Department of Pathology, and ⁴Department of Nephrology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
Objective: Renal survival is crucial in patients with idiopathic membranous nephropathy (IMN). Our aim was to identify baseline clinical and histopathological predictors of long-term renal survival in patients with IMN.
Materials and methods: In this retrospective, single-center cohort study, we reviewed 50 adults with biopsy-proven IMN (January 2009 – February 2019) who completed at least 60 months of follow-up. We recorded baseline age, sex, serum creatinine, serum albumin, 24-hour proteinuria, and the total renal chronicity score (Mayo Clinic Chronicity Score). Chronicity was classified as minimal (score 0 – 1) or non-minimal (score ≥ 2). The renal endpoint was defined as a ≥ two-fold increase in serum creatinine from baseline or the initiation of renal replacement therapy (RRT). Predictors of renal survival were assessed using univariate and multivariate Cox regression; renal survival probability was illustrated with Kaplan-Meier analysis.
Results: During the 5-year follow-up, 20 out of 50 patients (40%) reached the renal endpoint. Kaplan-Meier curves demonstrated a significant divergence: only 1 out of 30 patients (3.3%) in the minimal-chronicity group progressed, while 19 out of 20 patients (95%) with non-minimal chronicity experienced either a doubling of creatinine or required RRT (log-rank p < 0.001). In univariate analysis, older age, higher serum creatinine, lower serum albumin, albumin levels below 3 g/dL, and non-minimal chronicity were associated with poor outcomes. Multivariate Cox regression confirmed three independent predictors: baseline serum creatinine (HR 2.38, 95% CI 1.37 – 4.11, p = 0.02), serum albumin (HR 0.43, 95% CI 0.23 – 0.80, p = 0.008), and non-minimal chronicity score (HR 14.4, 95% CI 3.2 – 64.6, p < 0.001).
Conclusion: In IMN, a high total renal chronicity score on biopsy, elevated baseline serum creatinine, and hypoalbuminemia (< 3 g/dL) independently predict poor 5-year renal survival. Early recognition of non-minimal chronicity may facilitate timely therapeutic intervention and closer monitoring to mitigate progression to end-stage kidney disease.Correspondence to:
Hasan Kocaayan, MD
Izmir Katip Celebi University School of Medicine
Department of Internal Medicine
Division of Rheumatology
Izmir Ataturk Education and Research Hospital
Internal Medicine Clinic
35360, Karabağlar/İzmir, Turkey
Email: [email protected]

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