Reversal of endothelial dysfunction post-immunosuppressive therapy in adult-onset podocytopathy and primary membranous nephropathy

Abstract Background and aims The effect of nephrotic syndrome (NS) and its treatment on endothelial dysfunction is not evident. This study analyses the endothelial dysfunction in adult-onset NS and impact of Immunosuppressive therapy on same. Methods Newly diagnosed patients with adult-onset NS (podocytopathy and primary membranous nephropathy (PMN)) and normal renal function were enrolled.Flow mediated vasodilatation (FMD) assessed endothelial function and CD4+CD28null T cells, E-selectin and pulse wave velocities (PWV) were measured at baseline and after treatment to characterise this further. Monitoring included monthly proteinuria, serum albumin, creatinine and lipid profile at baseline and post-treatment. The healthy control(HC) included 25 voluntary kidney donors who were assessed for markers of endothelial dysfunction mentioned above. Results Fifty participants with new-onset NS were studied. Amongst NS group, 26 (52%) patients had PMN, while rest 24 (48%) had podocytopathy. Twenty-one (88%) patients amongst podocytopathy and 18 (69%) patients amongst PMN cohort were in either complete or partial remission at the end of 8 months. FMD at baseline in NS patients was significantly lower as compared to HC (p = 0.002) while PWV (p = 0.007), E-selectin (p  Conclusion Immunosuppressive treatment contributes substantially to the improvement of endothelial dysfunction present at baseline in NS patients. Persistent subtle endothelial dysfunction remains in sub-group of patients with PMN.