{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:06:32Z","timestamp":1789376792855,"version":"build-2803163510"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Pure membranous lupus nephritis [pMLN, Class V International Society of Nephrology\/Renal Pathology Society (ISN\/RPS)] is traditionally considered less aggressive than mixed forms of MLN (mMLN, Classes III\/IV\u00a0\u00b1\u00a0V ISN\/RPS). Only two trials have compared the outcome of these two forms of MLN, with inconclusive results. In this retrospective multicentre study, we assessed and compared the short and long-term outcomes of pMLN versus mMLN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients diagnosed with pMLN or mMLN on their first kidney biopsy were included. The main outcomes were complete renal response after 1 year, sustained complete response, relapse rates, chronic kidney disease (CKD)-free survival, and the composite outcome of kidney failure (KF)\/death-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 195 patients included, 96 (49.2%) pMLN had milder immunological features of active LN at baseline compared to 99 (50.8%) with mMLN. At kidney biopsy, the National Institute of Health activity and chronicity indices were lower in patients with pMLN (P\u00a0&amp;lt;\u00a0.001). Moreover, they received less intensive immunosuppressive treatment (less i.v.-steroids, lower use\/earlier withdrawal of the immunosuppressive regimen). Both groups achieved similar rates of responses, relapses, and kidney survival over follow-up.<\/jats:p>\n                    <jats:p>KF\/death-free survival was significantly lower in pMLN compared to mMLN (P\u00a0=\u00a0.026). In a Cox-model adjusted for baseline kidney function and induction immunosuppressive regimen, mMLN retained an 80% lower risk of KF\/death compared to pMLN (P\u00a0=\u00a0.0384). In a subgroup analysis, crude survival differences between pMLN and mMLN were confirmed only in patients biopsied before 2000.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study challenges the long-standing view of pMLN as a generally benign condition, suggesting that less intensive treatment of pure MLN may have contributed to less favourable hard outcomes in the long-term.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag264","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:49:38Z","timestamp":1786798178000},"source":"Crossref","is-referenced-by-count":0,"title":["Long-term kidney and patient outcomes in pure versus mixed lupus membranous nephritis"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6046-5501","authenticated-orcid":false,"given":"Martina","family":"Uzzo","sequence":"first","affiliation":[{"name":"Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital , Rozzano, Milan ,","place":["Italy"]},{"name":"Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisol","family":"Bracalenti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Padova , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Calatroni","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital , Rozzano, Milan ,","place":["Italy"]},{"name":"Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, 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Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin , AO Mauriziano, Turin ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Depascale","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Padova , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Maria","family":"Rossi","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Department of Medicine and Surgery, University of Parma , Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Limperio","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca , Monza ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato Alberto","family":"Sinico","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital , Rozzano, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0548-4983","authenticated-orcid":false,"given":"Andrea","family":"Doria","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Padova , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella Luisa","family":"Moroni","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital , Rozzano, Milan ,","place":["Italy"]},{"name":"Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Milan 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