Clinical And Pathological Analysis On Membranous Nephropathy In Yan’an

Objective: To understand the epidemiological character of membranousnephropathy(MN) in Yan’an and analyze the relationship between clinical features andpathological changes in patients who suffered from MN.Methods: Retrospectively analyze the clinical data、the distribution of pathologicalfeatures and clinical characters of MN patients who were diagnosied by renal biopsy atthe Yanan university affiliated hospital during December2009to November2012.Results:1.Sixty MN patients were collected,there are38(63.3%)male cases and22(36.7%)femalecases, men and women sick ratio is1.73:1.2.The age of the MN patients mainly focuses on20-39years old and40-49years old,andthe two groups are both more represented by men than women.3.According to the different causes,there are39(65%) cases of idiopathic membranousnephropathy(IMN),21(35%) cases of secondary membranous nephropathy;the mainciuses of the secondary membranous nephropathy is Chronic B-relatedHepatitis,18(85.7%) cases were collected,then2cases of systemic lupuserythematosus(SLE) and1case of psoriasis.4.In all of the18cases of Chronic B-related Hepatitis,5cases show that the etiology ofserology is negative.One of the5patients took the liver biopsy,and HBV were fond in theliver tissue.5.45(75%) cases of the MN patients perform as nephrotic syndrome(NS),15(25%) casesas the chronic nephritis,and24(40%) cases of the patients who accompanying microscopic,14(23.3%) cases of hematuria,hypertension and4(6.7%) cases of mild renalinsufficiency.6.In the60cases of the MN patients,27(45%) patients whose quantity of the24-hoursproteinuria bellows3.5g,and the male patients accounted for48.1%;33(55%) patientswhose quantity of the24-hours proteinuria greater than or equal to3.5g,and the malepatients accounted for75.8%.The incidence of heavy proteinuria in male is higher thanthe female(P<0.05).7.The main pathological classification are in phase Ⅱ and atypical membranousnephropathy,respectively accounted for28(46.7%) cases and27(45%) cases;2(3.3%)cases in phraseⅠand3(5%) cases in phase Ⅲ,we got no one in phase Ⅳ. Deposition ofIgG and C3are mainly fond when shown by immunofluorescence studies, respectivelyaccounted for60(100%) cases and56(93.3%) cases,36(60%) cases with IgAdeposition,49(81.7%) cases with IgM deposition;There are36(60%) cases displayed “fullhouse” phenomenon,they are respectively accounted for21cases of atypicalmembranous nephropathy,13cases in phase Ⅱa nd2cases in phase Ⅲ.8.There are no significant differences in gender,age, whether withhypertension,microscopic hematuria or not, the quantity of the24-hours proteinuria,serumalbumin,plasma-albumin,renal function and cholesterol at different pathologicalanalysis.(all P>0.05)Conclusion: The results of onset age, clinical characteristics and pathologicalclassification of the MN patients in yan ’an region of shaanxi province are consistent withother reports of China. In our group,the main pathological classification are in phase Ⅱand atypical membranous nephropathy,respectively accounted for46.7%and45%. Theresults disaccord with The reports before which show that the main pathologicalclassification are in phraseⅠand phase Ⅱ. But we only get3.3%in phraseⅠ. Thereasons might be the delay to diagnosis,the overlook the regular treatment in the earlyphase of the disease and the limitation of the small sample size in this study. Theproportion of hepatitis B related membranous nephropathy is higher than other areas of China.5cases show that the etiology of serology is negative.One of the5patients tookthe liver biopsy,and HBV were fond in the liver tissue.This report serves as a reminder toclinicians to make a point of testing HBV in the kidney tissues of MN patients’,or evenall of the kidney tissues.If condition permits, we should take liver biopsy to know moreof the liver.