Clinicopathological Features And Prognosis Of Membranous Nphropathy With Low-risk Proteinuria Level

Objective To explore the clinical,pathological and prognosis situation of membranous nephropathy with low-risk proteinuria level.Methods 233 patients with low-risk proteinuria level idiopathic membranous nephropathy diagnosed from May,2015 to November,2019 in XX hospital was selected as the research object.The general data（age,gender,basic disease,etc.）,laboratory indicators（including 24-h urinary protein,serum creatinine,serum albumin,blood lipid indicators,humoral immune indicators,etc.）,renal pathological data（light microscopy,electron microscopy,immunofluorescence）were collected.And the patients were divided into groups according to the presence or absence of renal interstitial lesions,the level of PLA2R deposition in renal tissue,hypertension,24-h urinary protein and age,to compare the clinical indexes and pathological characteristics between different groups.Among them,85 patients were treated with ACEI or ARB and symptomatic treatment without immunosuppressive treatment（including glucocorticoids and any immunosuppressive agents）.They were followed up for 9 months to observe the changes in clinical outcomes and conduct clinical analysis.Results 1.A total of 233 low-risk idiopathic membranous nephropathy patients were included in the research,including 136 cases with renal tubulointerstitial lesions.There were significant differences in age,systolic blood pressure,BMI,blood uric acid,GFR,TG,Cr,C3,IgM positive rate of renal tissue,renal vascular disease,spherical sclerosis,the proportion of segmental sclerosis and differences in renal interstitial lesions（P<0.05）.2.With the increase of 24-h urinary protein quantification,serum albumin,GFR and IgG decreased,and TCH and LDL increased.In the group of 24-h proteinuria>2g,the positive rates of systolic blood pressure,urine red blood cell count,UNAG/Cr,Cr and renal tissue Clq were all higher than those in the group of 24-h proteinuria ≤2g（P<0.05）.3.With the aging,systolic blood pressure,blood creatinine,and UNAG/Cr increased,while GFR and urine osmotic pressure decreased,and renal tubulointerstitial injury was aggravated（P<0.05）.4.There were statistical differences between BMI and Blood lipid related indexes among the"1+","2+" and "3+" groups in the deposition level of PLA2R in renal tissue（P<0.05）,while 24-h urine protein,blood creatinine,albumin,urine osmotic pressure,renal vascular disease,renal interstitial disease,the proportion of crescents,the proportion of globular sclerosis pellets and segmental sclerosis pellets have no significant difference.5.Patients in the hypertension group were older,with more severe glomerular and interstitial lesions,and low glomerular filtration rate.6.A total of 85 patients with IMN did not take immunosuppressive drugs from diagnosis to follow-up for 9 months,of which 61 patients reached the standard of complete remission,and the spontaneous complete remission rate was 72%.The lower the 24-hour urine protein level,the greater the probability of complete remission of IMN patients with non-immunosuppressive therapy.Conclusion 1.IMN elderly patients have a higher proportion of hypertension,severe renal interstitial lesions,and a low glomerular filtration rate.2.There was no significant correlation between PLA2R deposition in renal tissue and clinical manifestations or renal pathological changes.3.The spontaneous remission rate of IMN patients with low proteinuria after non-immunosuppressive treatment is high.