Analysis Of Clinical-pathological Feature And Therapeutic Effect Of Idiopathic Membranous Nephropathy

Objective:To analyze the clinical-pathological feature of Idiopathic Membranous Nephropathy( IMN),and to investigate the therapeutic effect of different therapeutic schemes.Method:61 cases with IMN diagnosed by renal biopsy were collected.The clinical and pathological data of idiopathic membranous nephropathy in our hospital were retrospectively analyzed and compared. 28 cases treated under the regular follow-up were retrospectively observed and analyzed. All patients with IMN are divided into two groups with their therapeutic effect(Effective and Ineffective group). Clinical date including blood pressure,urinary sediment, serum albumin, serum creatinine, 24-hours urinary protein quantitative were collected. Glomerular filtration rate(GFR) was estimated by abbreviated MDRD equation. Pathological changes were evaluated according to the Ehrenreich-Churg type.Result: The mean age of 61 patients was( 48.79±13.04)years old with a male to female ratio of 1.54:1(37 males and 24 females).The age distribution is form19 years old to 76 years old.The pre-biopsy median course was two monthes(3 days to 18 month). 49(80.3%) cases had Nephrotic syndrome, 12(19.7%) cases had Glomerulonephritis,54(88.5%) cases had microscope hematuria,14(23.0%) cases had hypersension, 7(11.5%) cases had hypothyroidism,15(24.6%) cases had renal inadequacy. All cases were classified as stage I(86.2%) or II(13.80%) membranous lension in pathology, stage III as well as IV membranous lesion were not collected. There was no significant difference in age and gender between Phase I and II membrane.And the pathological damage in patients with hypertension and high quantity of 24-hour proteinuria were heavier(P<0.05). Depositions of glomerular Ig G and C3 were founded in 89.66% and 72.41% of patients,while Ig A, Ig M and C4 were relatively rare.When grouped all IMN patients by the treatment medicine,the total remission and uneffective rates were 57.1% and 42.9% in corticosteroid group,and 66.7%,33.3% in corticosteroid plus tacrolimus group, and 66.7%,33.3% in corticosteroid plus cyclophosphamide. Conclusion: Idiopathic Membranous Nephropath often occurs in middle and old aged people.IMN mainly performs as Nephrotic Syndrome,accompanied by microscope hematuria. The main pathological stage are in phase I and II, and the pathological damage in patients with hypertension and high quantity of 24-hour proteinuria were heavier(P<0.05). There were excessive deposits of Ig G and C3 in kidney tissues. And the total remission rates in corticosteroid plus tacrolimus and corticosteroid plus cyclophosphamide group are more effective than in corticosteroid group, but more easy to relapse.Due to the less number of samples,the accuracy of the curative effect need a large number of samples and the long-term follow-up visit to made a further confirmation.