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Background <p>Relapse of membranous nephropathy (MN) and other glomerular diseases has been observed after COVID-19 infection. The risk factors contributing to disease progression in MN patients after contracting COVID-19 remain unclear.</p> Methods <p>This retrospective study included 656 consecutive patients with biopsy-proven primary MN who received treatment and were regularly followed up for over six months. Logistic regression analyses were conducted to identify risk factors for disease progression.</p> Results <p>Among the cohort, 555 patients (84.6%) contracted COVID-19 from November 11th, 2022, to February 22nd, 2023. Of them, 112 patients (20.2%) experienced a &gt; 50% increase in proteinuria, including 30 patients (5.4%) who experienced nephrotic syndrome relapse. Sixteen patients (2.9%) showed immune aggravation with elevated anti-PLA2R antibody levels, and five patients (0.9%) had immune relapse characterized by antibody reoccurrence. Kidney dysfunction, defined as an eGFR reduction &gt; 30% from baseline, occurred in 10 patients (1.8%), with two patients (0.4%) progressing to ESKD. Four patients (0.7%) died of respiratory failure. Overall, 132 patients (24.0%) experienced disease progression after COVID-19 infection. Multivariate logistic regression identified longer fever duration (OR 1.118, 95% CI 1.029–1.356, <i>P</i> = 0.018), withdrawal of immunosuppressants and/or steroids (OR 2.571, 95% CI 1.377–4.799, <i>P</i> = 0.003) and extended drug cessation (OR 1.113, 95% CI 1.045–1.186, <i>P</i> = 0.001) as independent risk factors for MN progression.</p> Conclusions <p>These findings suggest prompt antiviral treatment and minimizing the duration of immunosuppressant withdrawal to optimize kidney outcomes in MN patients with COVID-19.</p>

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Risk factors for relapse and aggravation in membranous nephropathy after COVID-19 infection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月11日

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  • Yue Shu,
  • Jing Huang,
  • Yi-miao Zhang,
  • Fang Wang,
  • Xin Wang,
  • Li-qiang Meng,
  • Xu-yang Cheng,
  • Gang Liu,
  • Ming-hui Zhao,
  • Zhao Cui

摘要

Background

Relapse of membranous nephropathy (MN) and other glomerular diseases has been observed after COVID-19 infection. The risk factors contributing to disease progression in MN patients after contracting COVID-19 remain unclear.

Methods

This retrospective study included 656 consecutive patients with biopsy-proven primary MN who received treatment and were regularly followed up for over six months. Logistic regression analyses were conducted to identify risk factors for disease progression.

Results

Among the cohort, 555 patients (84.6%) contracted COVID-19 from November 11th, 2022, to February 22nd, 2023. Of them, 112 patients (20.2%) experienced a > 50% increase in proteinuria, including 30 patients (5.4%) who experienced nephrotic syndrome relapse. Sixteen patients (2.9%) showed immune aggravation with elevated anti-PLA2R antibody levels, and five patients (0.9%) had immune relapse characterized by antibody reoccurrence. Kidney dysfunction, defined as an eGFR reduction > 30% from baseline, occurred in 10 patients (1.8%), with two patients (0.4%) progressing to ESKD. Four patients (0.7%) died of respiratory failure. Overall, 132 patients (24.0%) experienced disease progression after COVID-19 infection. Multivariate logistic regression identified longer fever duration (OR 1.118, 95% CI 1.029–1.356, P = 0.018), withdrawal of immunosuppressants and/or steroids (OR 2.571, 95% CI 1.377–4.799, P = 0.003) and extended drug cessation (OR 1.113, 95% CI 1.045–1.186, P = 0.001) as independent risk factors for MN progression.

Conclusions

These findings suggest prompt antiviral treatment and minimizing the duration of immunosuppressant withdrawal to optimize kidney outcomes in MN patients with COVID-19.