Clinical Characteristics And Prognosis Of Patients With Primary Podocytosis With Varying Degrees Of Immunoglobulin M Deposition

Objective:By comparing the clinical characteristics and response to hormone therapy of patients with primary podocytosis with different degrees of IgM deposition,the clinical significance of different degrees of IgM deposition in primary podocytosis was discussed,and the reference for clinical diagnosis,treatment and prognosis evaluation was provided.Methods:This study reviewed 249 patients with primary podocytosis who were pathologically diagnosed as IMN,MCD and FSGS after renal needle biopsy in the Department of Nephrology of North Jiangsu People’s Hospital from July 2016 to March2020.Among them,153 were IMN,65 were MCD and 31 were FSGS.IgM in glomeruli was detected by immunofluorescence assay and divided into three groups according to the deposition intensity: IgM(-)group(n = 97),IgM(1+)group(n = 117)and IgM(2+)group(n = 35).115 patients with successful follow-up were included as the final study subjects and divided into three groups according to the IgM deposition intensity: IgM(-)group(40 cases),IgM(1+)group(60 cases)and IgM(2+)group(15cases).Clinical datas,laboratory examination results and the deposition of immune complex after renal needle biopsy of patients in the three groups were recorded to compare whether there were differences in the laboratory examination and the deposition of immune complex in the three groups.During the treatment,the patients were followed up to record the 24 hours urinary protein quantitative,ALB,Scr,BUN,CKD-EPIScr equation estimating e GFR before treatment,4 weeks,8 weeks,12 weeks and 24 weeks after treatment,analysis the index changes of three groups of patients before and after treatment,compared with three groups of patients with 12 weeks and24 weeks after remission rate,recurrence and the proportion of renal insufficiency,assess the differences of three groups of patients with therapeutic effect.Patients were followed up for 10 months,and the end points were recurrence and adverse prognosis events.Kaplan-Meier survival analysis was used to evaluate the differences in recurrence and renal survival time among the three groups.Result:1.Clinical indicators: treatment before the IgM(2 +)group of 24 hours urinary protein quantitative and e GFR were higher than the rest of the two groups,the serum IgG quantitative is lower than the rest of the two groups,the difference was statistically significant(P < 0.05),the rest of the indicators include gender,age,body mass index,Alb,Scr,BUN,SUA,Glu,ALT,AST,TG,CHO,HDL-C,LDL-C,Cystatin C,Complement C1 q 、urine NAG enzyme differences had no statistical significance(P >0.05);immunopathological indicators: the deposit proportion of C4,C1 q and FIB in glomerulus of IgM(2+)group was significantly higher than that of the other two groups,with statistical significance(P < 0.05);there was no statistical significance in the deposit proportion of IgA,IgG and C3 among the three groups(P > 0.05).2.Comparison of renal function after treatment: at 4,8,12 and 24 weeks of treatment,the 24-hour urinary protein level and e GFR in the three groups were all lower than before,with statistically significant differences within groups(P < 0.05),but no statistically significant differences between groups(P > 0.05).ALB,SCR and BUN in the three groups were all increased as a whole compared with before,and there was statistical significance in intra-group comparison(P < 0.05),but no statistical significance in inter-group comparison(P > 0.05).3.Comparison of remission rate,recurrence rate and incidence of renal insufficiency after treatment: at 12 weeks of treatment,the remission rates of the three groups were 72%,85% and 80%,with no statistical significance(P > 0.05);at 24 weeks of treatment,the remission rates of the three groups were 80%,90% and 86.1%,and there was no statistical significance(P > 0.05).During treatment,the recurrence rates of the three groups were 17.5%,13.3% and 40%,and the difference was statistically significant(P=0.03).After 10 months of follow-up,the incidence of renal insufficiency was 25%,21.6% and 20%,with no statistical significance(P > 0.05).4.Survival analysis: during a follow-up of 10 months,end point events by recurrence,Kaplan Meier-survival analysis suggests that distribution of three groups of patients survival difference was statistically significant(the log rank test Χ~2 = 6.421,P= 0.04).Follow-up of 10 months,with poor prognosis for end point events,Kaplan Meier-survival analysis suggests that three groups there was no statistically significant difference of survival distribution(Log-rank test Χ~2 = 0.430,P = 0.087).Conclusion:1.The patients with IgM(2 +)deposition had higher urinary protein level and more severe immunofluorescence,which suggested that the patients with IgM(2 +)deposition were more serious,and it had a certain role in judging the clinical condition.2.The recurrence rate of patients with IgM(2+)deposition group was relatively higher during treatment.IgM(2+)deposition can be an independent risk factor for predicting the recurrence of primary podocytic disease,suggesting that patients with IgM(2+)deposition are prone to relapse during treatment,which has a certain guiding effect on treatment response.3.There was no significant difference in short-term renal survival among patients with different degrees of IgM deposition,and IgM(2+)deposition has not yet become an independent risk factor for renal function progression in patients with primary podocytosis.