Prognosis
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The degree of presenting proteinuria is considered the most important prognostic factor. Quantification of proteinuria is of major prognostic significance because proteinuria seems to have a “dose-dependent” effect on prognosis and on rates of spontaneous remission. As such, mild non-nephrotic proteinuria is associated with increased chances for spontaneous remission.<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref> The rate of remssion may be delayed to several years, especially when proteinuria becomes in the sub-nephrotic range; the rate of proteinuria reduction might be very slow and occur over several years before completely normal renal function is restored.<ref name="pmid22895519">{{cite journal| author=Radhakrishnan J, Cattran DC| title=The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient. | journal=Kidney Int | year= 2012 | volume= 82 | issue= 8 | pages= 840-56 | pmid=22895519 | doi=10.1038/ki.2012.280 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22895519 }} </ref> On the other hand, it is unlikely that patients with heavy proteinuria to experience spontaneous remission.<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref>
The degree of presenting proteinuria is considered the most important prognostic factor. Quantification of proteinuria is of major prognostic significance because proteinuria seems to have a “dose-dependent” effect on prognosis and on rates of spontaneous remission. As such, mild non-nephrotic proteinuria is associated with increased chances for spontaneous remission.<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref> The rate of remssion may be delayed to several years, especially when proteinuria becomes in the sub-nephrotic range; the rate of proteinuria reduction might be very slow and occur over several years before completely normal renal function is restored.<ref name="pmid22895519">{{cite journal| author=Radhakrishnan J, Cattran DC| title=The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient. | journal=Kidney Int | year= 2012 | volume= 82 | issue= 8 | pages= 840-56 | pmid=22895519 | doi=10.1038/ki.2012.280 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22895519 }} </ref> On the other hand, it is unlikely that patients with heavy proteinuria to experience spontaneous remission.<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref>
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| width=200px; bgcolor="#d9ff54" |'''Degree of Nephrotic-Range Proteinuria (g/24hrs)'''||width=200px; bgcolor="#d9ff54"|'''Patients With Spontaneous Remission (%)<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref>'''
| width=200px; bgcolor="#d9ff54" |'''Degree of Nephrotic-Range Proteinuria (g/24hrs)'''||width=200px; bgcolor="#d9ff54"|'''Patients With Spontaneous Remission (%)<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref>'''
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As such, the 3 main elements that favor good prognosis are as follows:
As such, the 3 main elements that favor good prognosis are as follows:
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| width=800px; bgcolor="#d9ff54" | '''Three Main Factors for Good Prognosis'''
| width=800px; bgcolor="#d9ff54" | '''Three Main Factors for Good Prognosis'''
Less quantities of proteinuria<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref><ref name="pmid10352189">{{cite journal| author=Laluck BJ, Cattran DC| title=Prognosis after a complete remission in adult patients with idiopathic membranous nephropathy. | journal=Am J Kidney Dis | year= 1999 | volume= 33 | issue= 6 | pages= 1026-32 | pmid=10352189 | doi=10.1016/S0272-6386(99)70138-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10352189 }} </ref>
Less quantities of proteinuria<ref name="pmid20110379">{{cite journal| author=Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A et al.| title=Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 4 | pages= 697-704 | pmid=20110379 | doi=10.1681/ASN.2009080861 | pmc=PMC2844306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20110379 }} </ref><ref name="pmid10352189">{{cite journal| author=Laluck BJ, Cattran DC| title=Prognosis after a complete remission in adult patients with idiopathic membranous nephropathy. | journal=Am J Kidney Dis | year= 1999 | volume= 33 | issue= 6 | pages= 1026-32 | pmid=10352189 | doi=10.1016/S0272-6386(99)70138-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10352189 }} </ref>