Histopathological predictors of renal outcomes in idiopathic membranous nephropathy with a focus on global sclerotic glomeruli ratio

Tunca, Onur; Turkmen, Aydin; EREN, NECMİ; Yadigar, Serap; Karagoz, Ferdi; DİNÇER, MEVLÜT; GÖK, Mahmut; Cevher, Simal; Tatar, Erhan; KUTLAY, SİM; Karaca, Cebrail; BAŞTÜRK, Taner; Dursun, Belda; DURANAY, Murat; Ozler, Tuba; Arikan, Hakki; Turkmen, Kultigin; YILDIZ, ABDULMECİT; KAZANCIOĞLU, RÜMEYZA; Kocyigit, İsmail; Ulu, Sena; Dheir, Hamad; ÖZDEMİR, Arzu; Karakan, Sebnem; Azak, Alper; GÖK OĞUZ, Ebru; Yılmaz, Zülfükar; Sahin, Garip; TANRISEV, Mehmet; Sengul, Erkan; Selcuk, Nedim; GÜL, CUMA; KAYA, BÜLENT; ÖĞÜTMEN, Melike; Oygar, Deren; Turgutalp, Kenan; Sayarlıoğlu, Hayriye; Gungor, Ozkan; Islam, Mahmud; Tahillioglu, Yagmur; Kazan, Sinan

doi:10.1038/s41598-026-61455-0

Histopathological predictors of renal outcomes in idiopathic membranous nephropathy with a focus on global sclerotic glomeruli ratio

Tunca O., Turkmen A., EREN N., Yadigar S., Karagoz F., DİNÇER M. T., ...Daha Fazla

Scientific Reports, cilt.16, sa.1, 2026 (SCI-Expanded, Scopus)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 16 Sayı: 1
Basım Tarihi: 2026
Doi Numarası: 10.1038/s41598-026-61455-0
Dergi Adı: Scientific Reports
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chemical Abstracts Core, EMBASE, MEDLINE, Directory of Open Access Journals, Zoological Record, Academic Search Ultimate (EBSCO), Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
Anahtar Kelimeler: Chronic kidney disease, global sclerotic glomeruli ratio, glomerulosclerosis, histopathology, idiopathic membranous nephropathy, prognostic marker, renal outcomes, tubular atrophy
Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
Van Yüzüncü Yıl Üniversitesi Adresli: Evet

Özet

Idiopathic membranous nephropathy (MN) shows variable renal outcomes, and reliable histologic markers for risk stratification are limited. The global sclerotic glomeruli ratio (GSGR) may reflect chronic kidney damage and help predict progression, but its prognostic value and optimal threshold remain unclear. We retrospectively analyzed 322 patients with biopsy-proven idiopathic MN from the Turkish Society of Nephrology-Glomerular Diseases Study Group registry, excluding those with an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m² at diagnosis or insufficient data. GSGR was calculated as the percentage of globally sclerotic glomeruli among total glomeruli. Histopathological parameters, including exudative glomerular changes, tubular atrophy/interstitial fibrosis (TA/IF), and vascular alterations, were semi-quantitatively graded according to the Renal Pathology Atlas (Fogo, 2022). Specifically, TA/IF was graded as: Grade 0 (< 5%), Grade 1 (5–25%), Grade 2 26–50%, and Grade 3 (> 50%) of cortical area involvement. Exudative changes were defined as intracapillary leukocyte accumulation and hyaline deposits in ≥ 25% of non-sclerotic glomeruli. The primary composite outcome was ≥ 50% eGFR decline from baseline, progression to eGFR < 15 mL/min/1.73 m², dialysis initiation, or kidney transplantation. Median follow-up was 60 months (IQR 48–72). Thirty patients (9.3%) reached the composite outcome. Receiver operating characteristic analysis identified a GSGR threshold of 15.7% (AUC 0.956; sensitivity 93.3%; specificity 82.7%). Patients with GSGR ≥ 15.7% had significantly higher event rates (35.1% vs. 1.2%; p < 0.001). In multivariate analysis, high GSGR, exudative changes, and response to immunosuppressive therapy independently predicted adverse outcomes. These associations remained significant across treatment subgroups. Sensitivity analyses confirmed these associations across multiple model specifications. Anti-PLA2R positivity correlated with higher baseline proteinuria but not independently with renal outcomes. A GSGR ≥ 15.7% is a strong, independent predictor of renal progression in idiopathic MN. Incorporating GSGR and exudative changes into risk stratification may improve prognostic assessment and therapeutic decision-making.