A Retrospective Analysis Of Manifestation And Treatment Of Idiopathic Membranous Nephropathy

Background:Idiopathic membranous nephropathy is one of a common pathological type of adult nephritic syndrome. Clinical data shows that IMN occurs mainly in elderly people with a predominant of male, the peak of age is 50 to 60 years old. IMN has an unpredictable natural history, its clinical manifestations and prognosises are various. 30 % to 40 % of patients can progress to ESRD in the 5 to 10 years. Serious complications of IMN will bring life-threatening even with stable renal function. So it is critical to early identify high-risk of IMN patients, to reduce the additional costs and risks at low-risk patients. The treatment of IMN patients have been heavily debated. Special treatment of IMN needs immunosuppressant. Recently, tacrolimus was get people’s attention because of its availability and few side effects. In this study, retrospectively analyzed of 137 patients’ clinical manifestations, laboratory tests, renal pathology and treatment efficacy.Objectives:To investigate the clinical and pathological features of patients with IMN, while observing therapeutic efficacy of CTX and of TAC. To provide reference for clinical diagnosis and treatment of IMN.Methods:Collected 137 patients with IMN from August 2012 to September 2015 in chronic kidney disease hospital outpatient. Recorded general information, baseline clinical and pathological features of 137 cases. Divided the objects into 5 groups based on age, and 3groups based on 24-hour urinary protein: the low-risk group, the medium-risk group and the high-risk group, analyzing the duration, SBP and laboratory parameters. The course of disease and laboratory parameters with GFR were analyzed by linear regression. All patients were followed up by chronic kidney disease outpatient to track and compare different treatment groups’ clinical remission between CTX and TAC. The Statistical Methods was used by SPSS 20.0 statistical software.Results:1. 137 IMN cases were involved, the age distribution of 40 to 60 years were 76 cases,accounting for 55.47%. The prevalence ratio of male and female is 1.85: 1. Clinical manifestations of NS were 106 cases, accounting for 77.37%. Patients with microscopic hematuria were 102 cases, accounting for 74.45%, of which 4 patients with macroscopic hematuria. But some patients did not defined the hematuria specific sources. 106 cases had the edema as the first clinical manifestations, accounting for77.37%.2. Grouping by the age: analysis the course, 24 h urine protein, SBP, GFR, ALB, BUN,SCr, TG and TCHO, showed that SBP, BUN and GFR have statistical significance between different age groups, P <0.05.3. The course, SBP, GFR, BUN, SCr, UA, TG, TCHO, C3, C4, Ig A, Ig M and Ig G was analyzed among the low-risk group, the medium-risk group and high-risk group. The results show that SBP, GFR, Scr, TCHO and Ig G has significance among the 3 groups,P <0.05.4. GFR with the course, 24-hour urinary protein, SBP, TG, TCHO, LDL and HDL were analyzed by correlation analysis, showed that GFR and 24-hour urinary protein was negatively correlated(r =- 0.182, P<0.05); GFR and HDL was positively correlated(r= 0.215, P <0.05).5. About 62 cases’( 45.26%) renal biopsy pathological types were classified as stageⅠ ~ Ⅱ, followed by atypical membranous nephropathy were 36 cases(26.28%),while stage Ⅲ and Ⅳ were not seen among those cases. When renal biopsy tissues were examinated by immunofluorescence, deposition of Ig G were seen in all cases,followed by C3 and C4 deposition, respectively accounted for 86.13% and 59.12%.Renal biopsy pathology of 64 cases were accompanied by glomerulosclerosis(46.72%), 91 cases were accompanied by tubulointerstitial(66.42%), small artery lesions in 42 cases(30.66%), 1 cases with FSGS(0.73%), and 4 cases(2.92%) of them appears crescent.6. 71 patients were treated with TAC and CTX for 6 months, the former is 50 cases and the latter is 20 cases. All treatment method could reduce urinary protein and elevate serum albumin levels. After 3 months of treatment, the results showed the clinical remission rate of TAC group was 62%, while CTX group was 33.3%, which has statistics significance between the two groups, P<0.05. After 6 months’ treatment, the clinical remission rate of TAC group was 90%, while CTX group was 85.7%, there were no statistically significant between the two groups, P>0.05.Conclusions:1. Idiopathic membranous nephropathy is inclined to middle-aged, and men have a relatively higher prevalence. Nephrotic syndrome is the main clinical manifestations.Edema is the first symptom.2. SBP, Scr, TCHO and Ig G can affect urinary protein; the degree of proteinuria and HDL levels can affect the GFR.3. Renal pathological types of IMN were given priority to stageⅠ~Ⅱ. The depositions of Ig G and C3 are mainly found in the immunofluorescence examination.4. Corticosteroids plus TAC or CTX can effectively relieve NS in IMN patients.Compared the two groups in short-term, the treatment of TAC group is more effective,better and faster than CTX group only in third month after six months.