Clinical features, course and prognosis of idiopathic membranous nephropathy depending on the presence of antibodies against M-type phospholipase A2 receptor

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"autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elías Jatem Escalante, Alfons Segarra Medrano, Clara Carnicer Cáceres, M. Adoración Martín-Gómez, María Teresa Salcedo Allende, Helena Ostos Roldan, Irene Agraz Pamplona" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Elías" "apellidos" => "Jatem Escalante" "email" => array:1 [ 0 => "jatemelias@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alfons" "apellidos" => "Segarra Medrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Clara" "apellidos" => "Carnicer Cáceres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "M. 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Log-rank: 0.141; p: 0.708." ] ] ] "textoCompleto" => "IntroductionMembranous nephropathy (MN) is the leading cause of nephrotic syndrome among adults.<a class="elsevierStyleCrossRef" href="#bib0130">1</a> It is clinically classified into idiopathic (IMN) or secondary, depending on the identification of an aetiology. When clinical or biochemical data suggesting a specific cause are not available, their differentiation based on the sole use of data derived from renal biopsies can be challenging.<a class="elsevierStyleCrossRefs" href="#bib0135">2,3</a> Several recent studies have reported that nearly 70% of IMN cases are associated with the presence of antibodies against M-type phospholipase A2 receptor (anti-PLA2R).<a class="elsevierStyleCrossRef" href="#bib0145">4</a> The likelihood of spontaneous remission<a class="elsevierStyleCrossRef" href="#bib0150">5</a> (SR) and treatment response is associated with antibody titres at diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0150">5–10</a> Nonetheless, the presence of anti-PLA2R antibodies in IMN patients was not shown to be associated with a particular clinical profile or to result in differences regarding clinical course, treatment response, or long-term prognosis. Also, and despite the majority of trials agreeing that the presence of anti-PLA2R antibodies is highly specific for idiopathic forms of MN,<a class="elsevierStyleCrossRefs" href="#bib0145">4,5,7,12–14</a> the said antibodies have been reported to be consistent with other potential aetiologies,<a class="elsevierStyleCrossRef" href="#bib0200">15</a> and around 30% of IMN patients are anti-PLA2R negative. Antibodies against other podocyte antigens whose clinical correlation is still under investigation have been described in this last group of patients,<a class="elsevierStyleCrossRefs" href="#bib0205">16–19</a> which is why the potential identification of secondary aetiologies over time remains largely uncertain. Yet, given that most trials had a transversal design, little information is available on the diagnosis of potential aetiologies of MN over time in anti-PLA2R positive and negative patients.The purpose of this study is to assess potential differences in initial clinical profile, clinical course, treatment response, or prognosis of IMN based on the presence or absence of anti-PLA2R antibodies.Patients and methodsWe conducted a retrospective study involving patients over 18 years old with a renal biopsy diagnosis of nephrotic syndrome secondary to MN between 1985 and 2009, who complied with the following criteria: (1) absence of an aetiology of MN, following a protocol study which ruled out neoplastic, systemic, and infectious diseases or exposure to drugs at diagnosis, and (2) available renal tissue samples for immunohistochemistry or serum samples at diagnosis for the measurement of circulating anti-PLA2R antibodies.Clinical, demographic, and biochemical variables were recorded at the time of diagnosis and during follow-up. Serum creatinine was determined using a compensated IDMS-traceable method (Hitachi Modular P-800 Roche Diagnostics, Berlin, Germany). The estimated glomerular filtration rate (eGFR) was measured using CKD-EPI.<a class="elsevierStyleCrossRef" href="#bib0225">20</a>Patients were classified into two groups based on the presence or absence of anti-PLA2R antibodies shown by immunohistochemistry in the renal biopsy or by the evidence of high circulating levels at diagnosis.The percentage of glomerular sclerosis was determined in all renal biopsies, together with the extent of interstitial fibrotic lesions, which was classified into four categories: 0: absent; grade I: ≤25%; grade II: 26–50%, and grade III: >50%. For biopsies where paraffin-embedded specimens were available, 5μm sections were made for anti-PLA2R antibody staining (HPA012657 Sigma–Aldrich Co. LLC, Munich, Germany) by immunohistochemistry (IHC) based on the previously described technique.<a class="elsevierStyleCrossRef" href="#bib0190">13</a>Circulating anti-PLA2R antibodies were measured using ELISA (Euroimmun, Lübeck, Germany; linearity: 6–1500RU/mL; lowest detection limit: 0.6RU/mL). Titres ≥20RU/mL were considered positive.Follow-up and controlsFollowing diagnosis, all patients underwent follow-up and observation prior to initiation of immunosuppression, during which symptomatic treatment was prescribed, including a low-sodium diet, and patients diagnosed from 1994 onwards received angiotensin receptor blockers and statins. Patients who did not achieve SR following observation received immunosuppressants.Outcome measures(1) Percentage and incidence of SR. (2) Incidence of response (total or partial remission) in the 12 months following first-line treatment initiation. (3) Time between treatment initiation and remission. (4) Percentage of patients experiencing recurrences, incidence and total number of recurrences. (5) Survival of renal function free from renal replacement therapy at the end of follow-up. (6) Survival of renal function free from chronic renal failure (CRF) at the end of follow-up. (7) Frequency of development of de novo neoplasia or other potential causes for MN during observation.DefinitionsComplete remission: proteinuria <0.3g/day in two consecutive controls. Partial remission: proteinuria <3.5g/day, and >0.3g/day in two consecutive controls. SR: complete or partial remission without immunosuppressants. Recurrence: proteinuria >3.5g/day associated with hypoalbuminaemia in two consecutive controls following treatment suppression. CRF: eGFR <60mL/min/1.73m2.The trial complied with the Helsinki Declaration parameters and was approved by the centre's Bioethics Committee.Statistical analysisResults are summarised as mean and typical deviation for normal distribution variables or as median and interquartile ranges for skewed distribution variables. Mean differences between study groups were analysed using Student's t test for independent data or Mann–Whitney U test. A variance analysis (ANOVA) was used for differences between more than two means. Ratio differences were analysed using Chi-square test or Fisher exact test. Independent predictors of SR were analysed using a stepwise logistic regression model. The discriminatory capacity was analysed using area under the ROC curve, and risk calibration was assessed through the Hosmer–Lemeshow test.<a class="elsevierStyleCrossRef" href="#bib0230">21</a> Independent variables associated with remission rates following treatment and overall survival of renal function at the end of follow-up were analysed using Kaplan–Meier estimates with the log-rank test for group differentiation, followed by Cox regression analysis to identify independent predictors. All p<0.05 values were considered statistically significant. The statistical program SPSS v. 20.0 was used.Results<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the clinical, biochemical, and pathological characteristics of the 85 patients enrolled in the study, based on the presence or absence of anti-PLA2R antibodies. The anti-PLA2R positive study group consisted of 55 patients: 15 (27.1%) had high titres of anti-PLA2R antibodies detected through ELISA, while immunohistochemistry was not possible owing to the absence of sufficient biopsy material; glomerular deposition was detected in 10 patients (17.6%) by immunohistochemistry, though no serum sample was available to determine antibody titres at diagnosis, and 30 (54.5%) patients had positive antibodies in both serum and renal biopsy.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Anti-PLA2R positive patients were significantly younger (p: 0.019), had lower creatinine levels and higher eGFR compared to anti-PLA2R negative patients (p: 0.033 and 0.027, respectively). When analysing baseline creatinine distribution in the two groups, three anti-PLA2R negative patients had exceptionally high creatinine levels compared to the rest of the group. No significant differences were observed between anti-PLA2R positive and negative patients after these patients were excluded from analysis. No differences were observed in the remaining clinical and pathological variables under study.Mean observation time prior to treatment was 8.34±6.25 months (median: 6.5; P25: 6 and P75: 9 months). A total of 20 patients (23.5%) achieved SR. The incidence of SR was of 0.041 episodes/patient/month. In the univariate analysis, SR was associated with lower proteinuria at baseline (6.84±3.10 vs 10.88±4.53g/24h; p<0.001), higher albuminaemia (2.82±0.65 vs 2.32±0.54g/dL; p: 0.001), and anti-PLA2R negativity (SR: 12/30 [40%] anti-PLA2R negative vs 8/55 [14.5%] in anti-PLA2R positive; p: 0.015). In the multivariate analysis, proteinuria and anti-PLA2R negativity were the single SR-independent predictors (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). No significant differences were reported in time to SR among anti-PLA2R positive and negative patients (7.10±2.60 vs 7.28±2.42 months; p: 0.893). No association between baseline antibody titres and frequency of SR was observed in the 45 patients with anti-PLA2R antibody titre values.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Immunosuppressants were administered to the 65 patients who did not achieve SR. Ten patients (15.6%) received prednisone alone, 14 (21.8%) received alkylating drugs (cyclophosphamide or chlorambucil) in combination with corticosteroids for 6 months, and 41 (63%) were treated with calcineurin inhibitors (cyclosporine or tacrolimus) for at least 6 months and a maximum of 12 months. No significant differences were reported in terms of kind of drug used as first-line therapy among anti-PLA2R positive and negative patients. Three (30%) of the 10 patients receiving corticosteroids alone achieved partial remission in the 12 months following treatment initiation. Two of them experienced recurrence. One received treatment with cyclophosphamide and achieved partial remission; the other received corticosteroids alone again and achieved partial remission. The remaining seven patients only received symptomatic treatment. At the end of follow-up, 6 of the 10 patients treated with corticosteroids (60%) developed CRF, but none progressed to stage V CRD.After exclusion of patients receiving steroids alone from the analysis of treatment response, 34/55 patients (61.81%) achieved partial or total remission and 21/55 (38.18%) did not achieve a response. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarises the clinical, biochemical, and pathological characteristics of patients based on the assessment of response to first-line treatment at 12 months from baseline. Remission was associated with lower baseline proteinuria. No significant association was reported between any of the remaining variables and baseline treatment response in the first 12 months. The incidence of remission in the first 12 months was similar among anti-PLA2R positive and negative patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>; p: 0.780). No differences were noted among patients receiving alkylating drugs or calcineurin inhibitors (p: 0.40).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Alternative immunosuppressants were administered to the 21 non-responders to first-line treatment. A total of nine (90.47%) patients received calcineurin inhibitors and two (9.52%) patients received calcineurin inhibitor plus rituximab, with total or partial remission observed in all cases.Mean follow-up was 75.3±49 months (median: 62; P25: 39; P75: 105 months). During this time, 32 of the 54 remitting patients (59.2%) experienced recurrence, including 6 of the 20 patients achieving SR (30%) and 26 of the 34 patients with post-treatment remission (76.4%). Mean recurrences were of 1.59±1.25 (interval 0–5). The incidence of recurrences was 0.033 episodes/patient/year. No statistically significant differences were reported between the frequency or incidence of recurrences and any of the study variables. No significant differences were reported in the number of recurrences between anti-PLA2R positive (1.32±0.56) and negative (1.94±1.74; p: 0.07) patients. The number of recurrences between patients receiving calcineurin inhibitors and patients receiving alkylating agents as first-line treatment was not significant either.Twenty-six (81.2%) patients experiencing recurrence received calcineurin inhibitors and six (18.8%) received alkylating agents, achieving total or partial remission of the nephrotic syndrome in 93.7% of cases (n: 30). Calcineurin inhibitors were continued for a mean time of 47.8±20.8 months (range 22–83) in ten patients experiencing more than three recurrences. These patients were subsequently treated with rituximab, achieving calcineurin inhibitor treatment suppression for all cases.<a class="elsevierStyleCrossRef" href="#bib0235">22</a>At the end of follow-up, survival of renal function free from renal replacement therapy was 95.2%. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> illustrates the survival of renal function free from renal replacement based on the presence or absence of anti-PLA2R antibodies. No significant differences were seen between groups. CRF-free survival of renal function was 70%. <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarises the variables associated with the development of CRF in the univariate (A) and multivariate (B) analyses. In this group, age, baseline renal function, and evidence of remission within the first year of immunosuppressive treatment were the single independent predictors of RF development.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Two patients, one anti-PLA2R positive, the other anti-PLA2R negative, developed de novo neoplasia during follow-up, both consistent with prostate adenocarcinomas. The time between diagnosis of MN and neoplasia was 3.5 years. An anti-PLA2R negative male patient under partial remission died during follow-up from an acute coronary syndrome 48 months after diagnosis of MN.DiscussionOur data reveal that IMN patients show similar biochemical and pathological profile at diagnosis – except for age – irrespective of the presence of anti-PLA2R antibodies. The likelihood of SR was significantly higher among anti-PLA2R negative patients after adjusting for proteinuria and baseline renal function. These data are consistent with those in a number of recent studies,<a class="elsevierStyleCrossRef" href="#bib0195">14</a> though in disagreement with others<a class="elsevierStyleCrossRefs" href="#bib0160">7,11</a>, and show no significant differences between anti-PLA2R positive and negative patients. The frequency of SR was slightly lower than that described in previous trials<a class="elsevierStyleCrossRefs" href="#bib0240">23–25</a> and, unlike these previous reports, no association was identified between renin-angiotensin-aldosterone blockers and baseline renal function. The absence of a link to the use of angiotensin II blockers may be explained by the fact that most patients diagnosed before 1994 had not been systematically prescribed with this type of drug following diagnosis. In addition, this fact could also partly account for the lower frequency of SR as reported in our cohort. Additionally, given that the frequency of SR increases over time,<a class="elsevierStyleCrossRef" href="#bib0250">25</a> longer observation periods might have resulted in increased frequency. The absence of a link to baseline renal function may be explained by normal renal function of most patients at baseline. Mean baseline creatinine and eGFR were lower among anti-PLA2R negative patients. The possibility of ST would be expected to be lower in this group. However, this was not observed in the univariate and multivariate analyses. The reason here lies in the fact that three patients from this group had extreme creatinine levels, which influenced the size of the mean values. Following exclusion from analysis, and after the comparison, no significant differences were observed. Anti-PLA2R negativity behaved as an independent variable and was associated with a higher probability of SR. These results may suggest that observation time prior to active immunosuppression can be extended in anti-PLA2R negative IMN patients, provided there is no exacerbation of renal function or proteinuria. Nevertheless, this finding must be confirmed by other trials before the suggestion can be considered conclusive.Post-treatment outcome, first-line treatment response, recurrences, and renal function survival rate were similar between anti-PLA2R positive and negative patients. These data are consistent with other recent studies already published.<a class="elsevierStyleCrossRefs" href="#bib0160">7,9,10,23</a> The presence of anti-PLA2R antibodies in the multivariate analysis was not an independent predictor of long-term survival of renal function.One last finding from our data is that no potential IMN-related diseases were diagnosed after extended follow-up in any of the patients initially diagnosed with IMN, irrespective of the presence or absence of anti-PLA2R antibodies, showing that the probability of a secondary aetiology is low, in both anti-PLA2R positive and negative patients, unless otherwise revealed at diagnosis.Our study is based on a retrospective cohort, and as such faces certain limitations and may be biased as a result of the influence of unmeasured variables. First, although the presence of anti-PLA2R antibodies in all patients classified as having positive anti-PLA2R antibodies is certain, they should have been identified through the combination of immunohistochemical and serological techniques, as the two sets of information were not concurrently available in some patients. Consequently, only partial analysis of the association between anti-PLA2R titres and the probability of SR was possible, thus affecting the statistical power of the results. Second, the study includes patients diagnosed and treated over a very long period, when study protocols, follow-up, and treatments differed and were not always governed by clearly defined guidelines. Although an analysis consistent with real clinical practice at each time point is possible, comparison of the data is therefore difficult, which might explain some of the differences found with other groups of patients in the literature, where decisions were made based on protocol- or guideline-defined criteria. Of note, 10 of the 64 patients without SR received corticosteroids alone. All had been treated before this treatment was shown in various studies to be ineffective in changing the clinical course of IMN. For this reason their progress is described separately, following exclusion from the efficacy analysis in terms of first-line treatment response.In conclusion, our data show that patients with IMN associated to anti-PLA2R antibodies are older at diagnosis and their frequency of SR is higher than that of anti-PLA2R positive patients. However, no differences between the two groups of patients were found in terms of response to first-line treatment, time to remission, frequency and number of recurrences, diagnosis of potential MN-related causes, and prognosis following observation.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres604421" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec618576" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres604422" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec618577" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Follow-up and controls" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Outcome measures" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Definitions" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-27" "fechaAceptado" => "2015-05-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec618576" "palabras" => array:4 [ 0 => "Idiopathic membranous nephropathy" 1 => "Anti-PLA2R antibodies" 2 => "Nephrotic syndrome" 3 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec618577" "palabras" => array:4 [ 0 => "Nefropatía membranosa idiopática" 1 => "Anticuerpos anti-PLA2R" 2 => "Síndrome nefrótico" 3 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "In membranous nephropathy, the presence of antibodies against M-type phospholipase A2 receptor is considered highly specific for idiopathic forms. However, no specific association to a particular clinical profile has been found for such antibodies. ObjectiveTo assess potential differences in initial clinical profile, course and prognosis of idiopathic membranous nephropathy depending on the presence of anti-PLA2R antibodies. MethodsEighty-five patients with idiopathic membranous nephropathy were included (55 anti-PLA2R-positive and 30 anti-PLA2R-negative). Clinical, biochemical and pathological variables were recorded at the time of diagnosis. Frequency of spontaneous remission, incidence of response to first-line therapy, frequency and number of recurrences, survival of renal function free from renal replacement therapy, survival of renal function free from chronic renal insufficiency and frequency of occurrence of malignant, infectious or autoimmune diseases during follow-up were recorded. ResultsAt the time of diagnosis, anti-PLA2R-negative patients were significantly older and had a higher frequency of spontaneous remission. No differences were noted in the response to first-line treatment, frequency and number of recurrences, survival of renal function free from renal replacement therapy, or survival of renal function free from chronic renal insufficiency. ConclusionsAnti-PLA2R-negative patients with idiopathic membranous nephropathy were older and experienced spontaneous remission more often than anti-PLA2R-positive patients. No differences in terms of treatment response, recurrences, and final prognosis were observed between both groups of patients." "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "En la nefropatía membranosa (NM), la presencia de anticuerpos antirreceptor tipo M de fosfolipasa A2 se considera altamente específica para las formas idiopáticas, pero no se ha demostrado que la presencia de dichos anticuerpos se asocie a un determinado perfil clínico. ObjetivoAnalizar si existe alguna diferencia en cuanto al perfil clínico inicial, evolución y pronóstico entre pacientes con NM idiopática en función de la presencia de anticuerpos anti-PLA2R. MétodosSe estudió a 85 enfermos con NM idiopática, 55 eran anti-PLA2R positivos y 30 negativos. Se registraron las variables clínicas, bioquímicas y anatomopatológicas al momento del diagnóstico, la frecuencia de remisión espontánea, la incidencia de respuesta al tratamiento de primera línea, la frecuencia y número de recidivas, la supervivencia de la función renal libre de tratamiento sustitutivo renal, la supervivencia de la función renal libre de insuficiencia renal crónica y la frecuencia de aparición de enfermedades neoplásicas, infecciosas o autoinmunes durante el seguimiento. ResultadosAl momento del diagnóstico, los enfermos anti-PLA2R negativos presentaron significativamente mayor edad y frecuencia de remisión espontánea. No se apreciaron diferencias en la respuesta al tratamiento de primera línea, frecuencia ni número de recidivas, supervivencia de la función renal libre de tratamiento sustitutivo renal ni supervivencia de función renal libre de insuficiencia renal crónica. ConclusionesLos enfermos con NM idiopática anti-PLA2R negativos presentaron mayor edad, menor filtrado glomerular inicial y mayor frecuencia de remisión espontánea que los enfermos anti-PLA2R positivos. Sin embargo, entre ambos grupos de enfermos, no se observaron diferencias en cuanto a la respuesta y al tratamiento, aparición de recidivas ni pronóstico final." "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Jatem Escalante E, Segarra Medrano A, Carnicer Cáceres C, Martín-Gómez MA, Salcedo Allende MT, Ostos Roldan H, et al. Características clínicas, evolución y pronóstico de la nefropatía membranosa idiopática en función de la presencia de anticuerpos contra el receptor tipo M de la fosfolipasa A2. Nefrologia. 2015;35:479–486." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1099 "Ancho" => 1644 "Tamanyo" => 86131 ] ] "descripcion" => array:1 [ "en" => "Incidence of remission in the first 12 months of treatment based on anti-PLA2R positivity. Log-rank: 0.141; p: 0.708." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1321 "Ancho" => 1659 "Tamanyo" => 78808 ] ] "descripcion" => array:1 [ "en" => "Renal survival in anti-PLA2R positive and negative patients. p: 0.6." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Only p values under 0.05 are highlighted in bold." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-PLA2R</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Positive \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Negative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patients % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.7 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.3 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Gender % (n)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.5 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.5 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.7 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49±16.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.8±15.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cholesterol total (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">340.2±85.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">326.5±68.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.461 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Albumin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.39±0.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.54±0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.282 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.03±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.48±1.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Proteinuria (g/24h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.6±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6±4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.064 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glomerular filtration (mL/min/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81.8±23.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.11±27.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.3 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High blood pressure % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.5 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Angiotensin blockers ii % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87.2 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86.6 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.937 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Spontaneous remission % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.5 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">First-line treatment (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.8 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.2 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Alkylating agents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.5 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.356 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Calcineurin inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.7 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66.7 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glomerular sclerosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.2±19.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.9±32.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.812 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fibrosis (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Absent % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.8 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.2 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.2 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43.8 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19.4 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.5 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.6 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.5 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989878.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline clinical and pathological features of patients based on the presence or absence of anti-PLA2R antibodies." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wald \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IC (95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.469 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97–1.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.493 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Proteinuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.241 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.802 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69–0.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-PLA2R negativity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.26–15.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989875.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Independent variables associated with spontaneous remission." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Total cholesterol: mean total cholesterolaemia." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Response \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No response \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patients % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.81 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.18 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Gender % (n)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.7 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.2 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.3 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.8 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.7±14.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.8±18.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total cholesterol (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">355.1±82.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">346.5±67.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Albumin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.35±0.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.18±0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.09±0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.36±0.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">eGFR (mL/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82.24±26.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.21±25.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Proteinuria (g/24h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11±4.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.67±2.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Anti-PLA2R</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Positive % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.41 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66.7 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.6 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glomerular sclerosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13±17.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.99±21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fibrosis (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Absent % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.3 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.3 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989877.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline clinical and pathological features of patients based on first-line treatment response." ] ] 5 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">(A) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CRF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Without CRF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patient % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.08 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.91 (51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.65±17.052 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.12±13.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Baseline eGFR (mL/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.91±24.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.19±21.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ACE treatment % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.6 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 (51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HBP % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.5 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.5 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glomerular sclerosis % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.05±28.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.78±15.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fibrosis (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Absent % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.8 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.7 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.9 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.2 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.8 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Remission in the first 12 months following start of treatment % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.8 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.2 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989879.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">(B) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wald \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CI (95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.083 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.172 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.087 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.018–1.161 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Baseline eGFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.558 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.918–0.986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Remission in the 12 months from start of immuno-suppression % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.055 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004–0.834 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989876.png" ] ] ] ] "descripcion" => array:1 [ "en" => "CRD-associated variables in the univariate (A) and multivariate (B) analysis." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of idiopathic glomerular disease: a prospective study" "autores" => array:1 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Características clínicas, evolución y pronóstico de la nefropatía membranosa idiopática en función de la presencia de anticuerpos contra el receptor tipo M de la fosfolipasa A2

Elías Jatem Escalantea,

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jatemelias@gmail.com

Corresponding author.

, Alfons Segarra Medranoa, Clara Carnicer Cáceresd, M. Adoración Martín-Gómezb, María Teresa Salcedo Allendec, Helena Ostos Roldana, Irene Agraz Pamplonaa

a Servicio de Nefrología, Hospital Universitari Vall d¿Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

b Unidad de Nefrología, Hospital de Poniente, El Ejido, Almería, Spain

c Servicio de Patología, Hospital Universitari Vall d¿Hebron, Barcelona, Spain

d Servicio de Bioquímica, Hospital Universitari Vall d¿Hebron, Barcelona, Spain

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Yet&#44; given that most trials had a transversal design&#44; little information is available on the diagnosis of potential aetiologies of MN over time in anti-PLA2R positive and negative patients&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The purpose of this study is to assess potential differences in initial clinical profile&#44; clinical course&#44; treatment response&#44; or prognosis of IMN based on the presence or absence of anti-PLA2R antibodies&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective study involving patients over 18 years old with a renal biopsy diagnosis of nephrotic syndrome secondary to MN between 1985 and 2009&#44; who complied with the following criteria&#58; &#40;1&#41; absence of an aetiology of MN&#44; following a protocol study which ruled out neoplastic&#44; systemic&#44; and infectious diseases or exposure to drugs at diagnosis&#44; and &#40;2&#41; available renal tissue samples for immunohistochemistry or serum samples at diagnosis for the measurement of circulating anti-PLA2R antibodies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Clinical&#44; demographic&#44; and biochemical variables were recorded at the time of diagnosis and during follow-up&#46; Serum creatinine was determined using a compensated IDMS-traceable method &#40;Hitachi Modular P-800 Roche Diagnostics&#44; Berlin&#44; Germany&#41;&#46; The estimated glomerular filtration rate &#40;eGFR&#41; was measured using CKD-EPI&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients were classified into two groups based on the presence or absence of anti-PLA2R antibodies shown by immunohistochemistry in the renal biopsy or by the evidence of high circulating levels at diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The percentage of glomerular sclerosis was determined in all renal biopsies&#44; together with the extent of interstitial fibrotic lesions&#44; which was classified into four categories&#58; 0&#58; absent&#59; grade I&#58; &#8804;25&#37;&#59; grade II&#58; 26&#8211;50&#37;&#44; and grade III&#58; &#62;50&#37;&#46; For biopsies where paraffin-embedded specimens were available&#44; 5<span class="elsevierStyleHsp" style=""></span>&#956;m sections were made for anti-PLA2R antibody staining &#40;HPA012657 Sigma&#8211;Aldrich Co&#46; LLC&#44; Munich&#44; Germany&#41; by immunohistochemistry &#40;IHC&#41; based on the previously described technique&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Circulating anti-PLA2R antibodies were measured using ELISA &#40;Euroimmun&#44; L&#252;beck&#44; Germany&#59; linearity&#58; 6&#8211;1500<span class="elsevierStyleHsp" style=""></span>RU&#47;mL&#59; lowest detection limit&#58; 0&#46;6<span class="elsevierStyleHsp" style=""></span>RU&#47;mL&#41;&#46; Titres &#8805;20<span class="elsevierStyleHsp" style=""></span>RU&#47;mL were considered positive&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Follow-up and controls</span><p id="par0040" class="elsevierStylePara elsevierViewall">Following diagnosis&#44; all patients underwent follow-up and observation prior to initiation of immunosuppression&#44; during which symptomatic treatment was prescribed&#44; including a low-sodium diet&#44; and patients diagnosed from 1994 onwards received angiotensin receptor blockers and statins&#46; Patients who did not achieve SR following observation received immunosuppressants&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Outcome measures</span><p id="par0045" class="elsevierStylePara elsevierViewall">&#40;1&#41; Percentage and incidence of SR&#46; &#40;2&#41; Incidence of response &#40;total or partial remission&#41; in the 12 months following first-line treatment initiation&#46; &#40;3&#41; Time between treatment initiation and remission&#46; &#40;4&#41; Percentage of patients experiencing recurrences&#44; incidence and total number of recurrences&#46; &#40;5&#41; Survival of renal function free from renal replacement therapy at the end of follow-up&#46; &#40;6&#41; Survival of renal function free from chronic renal failure &#40;CRF&#41; at the end of follow-up&#46; &#40;7&#41; Frequency of development of de novo neoplasia or other potential causes for MN during observation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definitions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Complete remission&#58; proteinuria &#60;0&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;day in two consecutive controls&#46; Partial remission&#58; proteinuria &#60;3&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;day&#44; and &#62;0&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;day in two consecutive controls&#46; SR&#58; complete or partial remission without immunosuppressants&#46; Recurrence&#58; proteinuria &#62;3&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;day associated with hypoalbuminaemia in two consecutive controls following treatment suppression&#46; CRF&#58; eGFR &#60;60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The trial complied with the Helsinki Declaration parameters and was approved by the centre&#39;s Bioethics Committee&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Results are summarised as mean and typical deviation for normal distribution variables or as median and interquartile ranges for skewed distribution variables&#46; Mean differences between study groups were analysed using Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent data or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; A variance analysis &#40;ANOVA&#41; was used for differences between more than two means&#46; Ratio differences were analysed using Chi-square test or Fisher exact test&#46; Independent predictors of SR were analysed using a stepwise logistic regression model&#46; The discriminatory capacity was analysed using area under the ROC curve&#44; and risk calibration was assessed through the Hosmer&#8211;Lemeshow test&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> Independent variables associated with remission rates following treatment and overall survival of renal function at the end of follow-up were analysed using Kaplan&#8211;Meier estimates with the log-rank test for group differentiation&#44; followed by Cox regression analysis to identify independent predictors&#46; All <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 values were considered statistically significant&#46; The statistical program SPSS v&#46; 20&#46;0 was used&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the clinical&#44; biochemical&#44; and pathological characteristics of the 85 patients enrolled in the study&#44; based on the presence or absence of anti-PLA2R antibodies&#46; The anti-PLA2R positive study group consisted of 55 patients&#58; 15 &#40;27&#46;1&#37;&#41; had high titres of anti-PLA2R antibodies detected through ELISA&#44; while immunohistochemistry was not possible owing to the absence of sufficient biopsy material&#59; glomerular deposition was detected in 10 patients &#40;17&#46;6&#37;&#41; by immunohistochemistry&#44; though no serum sample was available to determine antibody titres at diagnosis&#44; and 30 &#40;54&#46;5&#37;&#41; patients had positive antibodies in both serum and renal biopsy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Anti-PLA2R positive patients were significantly younger &#40;<span class="elsevierStyleItalic">p</span>&#58; 0&#46;019&#41;&#44; had lower creatinine levels and higher eGFR compared to anti-PLA2R negative patients &#40;<span class="elsevierStyleItalic">p</span>&#58; 0&#46;033 and 0&#46;027&#44; respectively&#41;&#46; When analysing baseline creatinine distribution in the two groups&#44; three anti-PLA2R negative patients had exceptionally high creatinine levels compared to the rest of the group&#46; No significant differences were observed between anti-PLA2R positive and negative patients after these patients were excluded from analysis&#46; No differences were observed in the remaining clinical and pathological variables under study&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Mean observation time prior to treatment was 8&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;25 months &#40;median&#58; 6&#46;5&#59; P<span class="elsevierStyleInf">25</span>&#58; 6 and P<span class="elsevierStyleInf">75</span>&#58; 9 months&#41;&#46; A total of 20 patients &#40;23&#46;5&#37;&#41; achieved SR&#46; The incidence of SR was of 0&#46;041 episodes&#47;patient&#47;month&#46; In the univariate analysis&#44; SR was associated with lower proteinuria at baseline &#40;6&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;10 vs 10&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;53<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; higher albuminaemia &#40;2&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;65 vs 2&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;54<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#59; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;001&#41;&#44; and anti-PLA2R negativity &#40;SR&#58; 12&#47;30 &#91;40&#37;&#93; anti-PLA2R negative vs 8&#47;55 &#91;14&#46;5&#37;&#93; in anti-PLA2R positive&#59; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;015&#41;&#46; In the multivariate analysis&#44; proteinuria and anti-PLA2R negativity were the single SR-independent predictors &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; No significant differences were reported in time to SR among anti-PLA2R positive and negative patients &#40;7&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;60 vs 7&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;42 months&#59; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;893&#41;&#46; No association between baseline antibody titres and frequency of SR was observed in the 45 patients with anti-PLA2R antibody titre values&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Immunosuppressants were administered to the 65 patients who did not achieve SR&#46; Ten patients &#40;15&#46;6&#37;&#41; received prednisone alone&#44; 14 &#40;21&#46;8&#37;&#41; received alkylating drugs &#40;cyclophosphamide or chlorambucil&#41; in combination with corticosteroids for 6 months&#44; and 41 &#40;63&#37;&#41; were treated with calcineurin inhibitors &#40;cyclosporine or tacrolimus&#41; for at least 6 months and a maximum of 12 months&#46; No significant differences were reported in terms of kind of drug used as first-line therapy among anti-PLA2R positive and negative patients&#46; Three &#40;30&#37;&#41; of the 10 patients receiving corticosteroids alone achieved partial remission in the 12 months following treatment initiation&#46; Two of them experienced recurrence&#46; One received treatment with cyclophosphamide and achieved partial remission&#59; the other received corticosteroids alone again and achieved partial remission&#46; The remaining seven patients only received symptomatic treatment&#46; At the end of follow-up&#44; 6 of the 10 patients treated with corticosteroids &#40;60&#37;&#41; developed CRF&#44; but none progressed to stage V CRD&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">After exclusion of patients receiving steroids alone from the analysis of treatment response&#44; 34&#47;55 patients &#40;61&#46;81&#37;&#41; achieved partial or total remission and 21&#47;55 &#40;38&#46;18&#37;&#41; did not achieve a response&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarises the clinical&#44; biochemical&#44; and pathological characteristics of patients based on the assessment of response to first-line treatment at 12 months from baseline&#46; Remission was associated with lower baseline proteinuria&#46; No significant association was reported between any of the remaining variables and baseline treatment response in the first 12 months&#46; The incidence of remission in the first 12 months was similar among anti-PLA2R positive and negative patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#59; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;780&#41;&#46; No differences were noted among patients receiving alkylating drugs or calcineurin inhibitors &#40;<span class="elsevierStyleItalic">p</span>&#58; 0&#46;40&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Alternative immunosuppressants were administered to the 21 non-responders to first-line treatment&#46; A total of nine &#40;90&#46;47&#37;&#41; patients received calcineurin inhibitors and two &#40;9&#46;52&#37;&#41; patients received calcineurin inhibitor plus rituximab&#44; with total or partial remission observed in all cases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Mean follow-up was 75&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49 months &#40;median&#58; 62&#59; P<span class="elsevierStyleInf">25</span>&#58; 39&#59; P<span class="elsevierStyleInf">75</span>&#58; 105 months&#41;&#46; During this time&#44; 32 of the 54 remitting patients &#40;59&#46;2&#37;&#41; experienced recurrence&#44; including 6 of the 20 patients achieving SR &#40;30&#37;&#41; and 26 of the 34 patients with post-treatment remission &#40;76&#46;4&#37;&#41;&#46; Mean recurrences were of 1&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;25 &#40;interval 0&#8211;5&#41;&#46; The incidence of recurrences was 0&#46;033 episodes&#47;patient&#47;year&#46; No statistically significant differences were reported between the frequency or incidence of recurrences and any of the study variables&#46; No significant differences were reported in the number of recurrences between anti-PLA2R positive &#40;1&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#41; and negative &#40;1&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;74&#59; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;07&#41; patients&#46; The number of recurrences between patients receiving calcineurin inhibitors and patients receiving alkylating agents as first-line treatment was not significant either&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Twenty-six &#40;81&#46;2&#37;&#41; patients experiencing recurrence received calcineurin inhibitors and six &#40;18&#46;8&#37;&#41; received alkylating agents&#44; achieving total or partial remission of the nephrotic syndrome in 93&#46;7&#37; of cases &#40;<span class="elsevierStyleItalic">n</span>&#58; 30&#41;&#46; Calcineurin inhibitors were continued for a mean time of 47&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;8 months &#40;range 22&#8211;83&#41; in ten patients experiencing more than three recurrences&#46; These patients were subsequently treated with rituximab&#44; achieving calcineurin inhibitor treatment suppression for all cases&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">At the end of follow-up&#44; survival of renal function free from renal replacement therapy was 95&#46;2&#37;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> illustrates the survival of renal function free from renal replacement based on the presence or absence of anti-PLA2R antibodies&#46; No significant differences were seen between groups&#46; CRF-free survival of renal function was 70&#37;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarises the variables associated with the development of CRF in the univariate &#40;A&#41; and multivariate &#40;B&#41; analyses&#46; In this group&#44; age&#44; baseline renal function&#44; and evidence of remission within the first year of immunosuppressive treatment were the single independent predictors of RF development&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Two patients&#44; one anti-PLA2R positive&#44; the other anti-PLA2R negative&#44; developed de novo neoplasia during follow-up&#44; both consistent with prostate adenocarcinomas&#46; The time between diagnosis of MN and neoplasia was 3&#46;5 years&#46; An anti-PLA2R negative male patient under partial remission died during follow-up from an acute coronary syndrome 48 months after diagnosis of MN&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Our data reveal that IMN patients show similar biochemical and pathological profile at diagnosis &#8211; except for age &#8211; irrespective of the presence of anti-PLA2R antibodies&#46; The likelihood of SR was significantly higher among anti-PLA2R negative patients after adjusting for proteinuria and baseline renal function&#46; These data are consistent with those in a number of recent studies&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> though in disagreement with others<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;11</span></a>&#44; and show no significant differences between anti-PLA2R positive and negative patients&#46; The frequency of SR was slightly lower than that described in previous trials<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">23&#8211;25</span></a> and&#44; unlike these previous reports&#44; no association was identified between renin-angiotensin-aldosterone blockers and baseline renal function&#46; The absence of a link to the use of angiotensin II blockers may be explained by the fact that most patients diagnosed before 1994 had not been systematically prescribed with this type of drug following diagnosis&#46; In addition&#44; this fact could also partly account for the lower frequency of SR as reported in our cohort&#46; Additionally&#44; given that the frequency of SR increases over time&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> longer observation periods might have resulted in increased frequency&#46; The absence of a link to baseline renal function may be explained by normal renal function of most patients at baseline&#46; Mean baseline creatinine and eGFR were lower among anti-PLA2R negative patients&#46; The possibility of ST would be expected to be lower in this group&#46; However&#44; this was not observed in the univariate and multivariate analyses&#46; The reason here lies in the fact that three patients from this group had extreme creatinine levels&#44; which influenced the size of the mean values&#46; Following exclusion from analysis&#44; and after the comparison&#44; no significant differences were observed&#46; Anti-PLA2R negativity behaved as an independent variable and was associated with a higher probability of SR&#46; These results may suggest that observation time prior to active immunosuppression can be extended in anti-PLA2R negative IMN patients&#44; provided there is no exacerbation of renal function or proteinuria&#46; Nevertheless&#44; this finding must be confirmed by other trials before the suggestion can be considered conclusive&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Post-treatment outcome&#44; first-line treatment response&#44; recurrences&#44; and renal function survival rate were similar between anti-PLA2R positive and negative patients&#46; These data are consistent with other recent studies already published&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;9&#44;10&#44;23</span></a> The presence of anti-PLA2R antibodies in the multivariate analysis was not an independent predictor of long-term survival of renal function&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">One last finding from our data is that no potential IMN-related diseases were diagnosed after extended follow-up in any of the patients initially diagnosed with IMN&#44; irrespective of the presence or absence of anti-PLA2R antibodies&#44; showing that the probability of a secondary aetiology is low&#44; in both anti-PLA2R positive and negative patients&#44; unless otherwise revealed at diagnosis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study is based on a retrospective cohort&#44; and as such faces certain limitations and may be biased as a result of the influence of unmeasured variables&#46; First&#44; although the presence of anti-PLA2R antibodies in all patients classified as having positive anti-PLA2R antibodies is certain&#44; they should have been identified through the combination of immunohistochemical and serological techniques&#44; as the two sets of information were not concurrently available in some patients&#46; Consequently&#44; only partial analysis of the association between anti-PLA2R titres and the probability of SR was possible&#44; thus affecting the statistical power of the results&#46; Second&#44; the study includes patients diagnosed and treated over a very long period&#44; when study protocols&#44; follow-up&#44; and treatments differed and were not always governed by clearly defined guidelines&#46; Although an analysis consistent with real clinical practice at each time point is possible&#44; comparison of the data is therefore difficult&#44; which might explain some of the differences found with other groups of patients in the literature&#44; where decisions were made based on protocol- or guideline-defined criteria&#46; Of note&#44; 10 of the 64 patients without SR received corticosteroids alone&#46; All had been treated before this treatment was shown in various studies to be ineffective in changing the clinical course of IMN&#46; For this reason their progress is described separately&#44; following exclusion from the efficacy analysis in terms of first-line treatment response&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; our data show that patients with IMN associated to anti-PLA2R antibodies are older at diagnosis and their frequency of SR is higher than that of anti-PLA2R positive patients&#46; However&#44; no differences between the two groups of patients were found in terms of response to first-line treatment&#44; time to remission&#44; frequency and number of recurrences&#44; diagnosis of potential MN-related causes&#44; and prognosis following observation&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In membranous nephropathy&#44; the presence of antibodies against M-type phospholipase A2 receptor is considered highly specific for idiopathic forms&#46; However&#44; no specific association to a particular clinical profile has been found for such antibodies&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess potential differences in initial clinical profile&#44; course and prognosis of idiopathic membranous nephropathy depending on the presence of anti-PLA2R antibodies&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eighty-five patients with idiopathic membranous nephropathy were included &#40;55 anti-PLA2R-positive and 30 anti-PLA2R-negative&#41;&#46; Clinical&#44; biochemical and pathological variables were recorded at the time of diagnosis&#46; Frequency of spontaneous remission&#44; incidence of response to first-line therapy&#44; frequency and number of recurrences&#44; survival of renal function free from renal replacement therapy&#44; survival of renal function free from chronic renal insufficiency and frequency of occurrence of malignant&#44; infectious or autoimmune diseases during follow-up were recorded&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">At the time of diagnosis&#44; anti-PLA2R-negative patients were significantly older and had a higher frequency of spontaneous remission&#46; No differences were noted in the response to first-line treatment&#44; frequency and number of recurrences&#44; survival of renal function free from renal replacement therapy&#44; or survival of renal function free from chronic renal insufficiency&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Anti-PLA2R-negative patients with idiopathic membranous nephropathy were older and experienced spontaneous remission more often than anti-PLA2R-positive patients&#46; No differences in terms of treatment response&#44; recurrences&#44; and final prognosis were observed between both groups of patients&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:1 [
            "identificador" => "abst0005"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En la nefropat&#237;a membranosa &#40;NM&#41;&#44; la presencia de anticuerpos antirreceptor tipo M de fosfolipasa A2 se considera altamente espec&#237;fica para las formas idiop&#225;ticas&#44; pero no se ha demostrado que la presencia de dichos anticuerpos se asocie a un determinado perfil cl&#237;nico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar si existe alguna diferencia en cuanto al perfil cl&#237;nico inicial&#44; evoluci&#243;n y pron&#243;stico entre pacientes con NM idiop&#225;tica en funci&#243;n de la presencia de anticuerpos anti-PLA2R&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 85 enfermos con NM idiop&#225;tica&#44; 55 eran anti-PLA2R positivos y 30 negativos&#46; Se registraron las variables cl&#237;nicas&#44; bioqu&#237;micas y anatomopatol&#243;gicas al momento del diagn&#243;stico&#44; la frecuencia de remisi&#243;n espont&#225;nea&#44; la incidencia de respuesta al tratamiento de primera l&#237;nea&#44; la frecuencia y n&#250;mero de recidivas&#44; la supervivencia de la funci&#243;n renal libre de tratamiento sustitutivo renal&#44; la supervivencia de la funci&#243;n renal libre de insuficiencia renal cr&#243;nica y la frecuencia de aparici&#243;n de enfermedades neopl&#225;sicas&#44; infecciosas o autoinmunes durante el seguimiento&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Al momento del diagn&#243;stico&#44; los enfermos anti-PLA2R negativos presentaron significativamente mayor edad y frecuencia de remisi&#243;n espont&#225;nea&#46; No se apreciaron diferencias en la respuesta al tratamiento de primera l&#237;nea&#44; frecuencia ni n&#250;mero de recidivas&#44; supervivencia de la funci&#243;n renal libre de tratamiento sustitutivo renal ni supervivencia de funci&#243;n renal libre de insuficiencia renal cr&#243;nica&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los enfermos con NM idiop&#225;tica anti-PLA2R negativos presentaron mayor edad&#44; menor filtrado glomerular inicial y mayor frecuencia de remisi&#243;n espont&#225;nea que los enfermos anti-PLA2R positivos&#46; Sin embargo&#44; entre ambos grupos de enfermos&#44; no se observaron diferencias en cuanto a la respuesta y al tratamiento&#44; aparici&#243;n de recidivas ni pron&#243;stico final&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:1 [
            "identificador" => "abst0030"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Jatem Escalante E&#44; Segarra Medrano A&#44; Carnicer C&#225;ceres C&#44; Mart&#237;n-G&#243;mez MA&#44; Salcedo Allende MT&#44; Ostos Roldan H&#44; et al&#46; Caracter&#237;sticas cl&#237;nicas&#44; evoluci&#243;n y pron&#243;stico de la nefropat&#237;a membranosa idiop&#225;tica en funci&#243;n de la presencia de anticuerpos contra el receptor tipo M de la fosfolipasa A2&#46; Nefrologia&#46; 2015&#59;35&#58;479&#8211;486&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1099
            "Ancho" => 1644
            "Tamanyo" => 86131
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Incidence of remission in the first 12 months of treatment based on anti-PLA2R positivity&#46; Log-rank&#58; 0&#46;141&#59; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;708&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1321
            "Ancho" => 1659
            "Tamanyo" => 78808
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Renal survival in anti-PLA2R positive and negative patients&#46; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;6&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Only <span class="elsevierStyleItalic">p</span> values under 0&#46;05 are highlighted in bold&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-PLA2R</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Patients &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;7 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;3 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Gender &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;5 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;7 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;019</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Cholesterol total &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">340&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>85&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">326&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;461&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Albumin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Creatinine &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;033</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Proteinuria &#40;g&#47;24</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;064&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Glomerular filtration &#40;mL&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;027</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;3 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;3 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">High blood pressure &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Angiotensin blockers <span class="elsevierStyleSmallCaps">ii</span> &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&#46;2 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#46;6 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Spontaneous remission &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;5 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;015</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">First-line treatment &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;8 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alkylating agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;5 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Calcineurin inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;7 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;7 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Glomerular sclerosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;812&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fibrosis &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Absent &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;8 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;2 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;2 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#46;8 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;4 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;5 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;6 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;5 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Baseline clinical and pathological features of patients based on the presence or absence of anti-PLA2R antibodies&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wald&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IC &#40;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;469&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97&#8211;1&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;493&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;802&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&#8211;0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;004</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-PLA2R negativity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;26&#8211;15&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;020</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Independent variables associated with spontaneous remission&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Total cholesterol&#58; mean total cholesterolaemia&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Patients &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;81 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;18 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Gender &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;7 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#46;2 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;8 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Total cholesterol &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">355&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>82&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">346&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>67&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Albumin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Creatinine &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">eGFR &#40;mL&#47;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Proteinuria &#40;g&#47;24</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;018</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Anti-PLA2R</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Positive &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#46;41 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;7 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;6 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;3 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Glomerular sclerosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fibrosis &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Absent &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;3 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;3 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;3 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Baseline clinical and pathological features of patients based on first-line treatment response&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;A&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Without CRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Patient &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;08 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;91 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Baseline eGFR &#40;mL&#47;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">ACE treatment &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;6 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">HBP &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;5 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;5 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Glomerular sclerosis &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fibrosis &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Absent &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;8 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;7 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;9 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;8 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Remission in the first 12 months following start of treatment &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;8 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;2 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;B&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;083&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;087&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;018&#8211;1&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Baseline eGFR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;558&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;918&#8211;0&#46;986&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Remission in the 12 months from start of immuno-suppression &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&#8211;0&#46;834&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CRD-associated variables in the univariate &#40;A&#41; and multivariate &#40;B&#41; analysis&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:25 [
            0 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of idiopathic glomerular disease&#58; a prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;T&#46; Tiebosch"
                            1 => "J&#46; Wolters"
                            2 => "P&#46;F&#46; Frederik"
                            3 => "T&#46;W&#46; van der Wiel"
                            4 => "E&#46; Zeppenfeldt"
                            5 => "P&#46;J&#46; van Breda Vriesman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "1987"
                        "volumen" => "32"
                        "paginaInicial" => "112"
                        "paginaFinal" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3626293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetomaternal alloimmunization with antenatal glomerulopathies"
                      "autores" => array:1 [
                        0 => array:2 [
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2015.10.006

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Year/Month	Html	Pdf	Total

2024 November	10	11	21
2024 October	49	36	85
2024 September	46	27	73
2024 August	64	47	111
2024 July	92	27	119
2024 June	78	36	114
2024 May	76	36	112
2024 April	52	30	82
2024 March	39	26	65
2024 February	39	30	69
2024 January	40	19	59
2023 December	33	27	60
2023 November	42	26	68
2023 October	89	32	121
2023 September	269	24	293
2023 August	218	28	246
2023 July	65	27	92
2023 June	83	20	103
2023 May	70	29	99
2023 April	39	16	55
2023 March	52	24	76
2023 February	47	18	65
2023 January	42	30	72
2022 December	98	34	132
2022 November	63	34	97
2022 October	137	37	174
2022 September	48	32	80
2022 August	50	45	95
2022 July	39	43	82
2022 June	40	48	88
2022 May	55	28	83
2022 April	62	48	110
2022 March	63	52	115
2022 February	79	44	123
2022 January	69	32	101
2021 December	43	45	88
2021 November	66	35	101
2021 October	49	44	93
2021 September	48	31	79
2021 August	87	31	118
2021 July	75	34	109
2021 June	79	19	98
2021 May	76	38	114
2021 April	98	24	122
2021 March	58	19	77
2021 February	42	14	56
2021 January	39	19	58
2020 December	37	8	45
2020 November	45	21	66
2020 October	32	14	46
2020 September	51	8	59
2020 August	32	16	48
2020 July	47	14	61
2020 June	38	10	48
2020 May	51	20	71
2020 April	55	15	70
2020 March	38	19	57
2020 February	74	25	99
2020 January	55	25	80
2019 December	67	24	91
2019 November	80	30	110
2019 October	58	21	79
2019 September	65	25	90
2019 August	74	18	92
2019 July	98	21	119
2019 June	150	34	184
2019 May	96	30	126
2019 April	135	46	181
2019 March	67	27	94
2019 February	60	30	90
2019 January	61	27	88
2018 December	259	46	305
2018 November	503	26	529
2018 October	359	26	385
2018 September	211	20	231
2018 August	178	19	197
2018 July	114	19	133
2018 June	102	19	121
2018 May	138	11	149
2018 April	128	7	135
2018 March	109	8	117
2018 February	74	7	81
2018 January	112	8	120
2017 December	76	7	83
2017 November	94	13	107
2017 October	29	8	37
2017 September	67	10	77
2017 August	68	16	84
2017 July	49	5	54
2017 June	64	15	79
2017 May	55	5	60
2017 April	58	20	78
2017 March	46	4	50
2017 February	42	16	58
2017 January	37	9	46
2016 December	60	9	69
2016 November	71	15	86
2016 October	117	13	130
2016 September	144	3	147
2016 August	157	7	164
2016 July	177	8	185
2016 June	112	0	112
2016 May	183	0	183
2016 April	160	0	160
2016 March	150	0	150
2016 February	162	0	162
2016 January	119	0	119
2015 December	106	0	106
2015 November	51	0	51

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