Correlation Analysis Between Clinical And Pathological Characteristics Of Atypical Membranous Nephropathy In Middle-Aged And Elderly Patients And TCM Syndrome Types

Objective To explore the correlation between clinicopathology and TCM syndrome types of middle-aged and elderly atypical membranous nephropathy（AMN）.Methods AMN patients with idiopathic membranous nephropathy（IMN）and secondary membranous nephropathy（SMN）who underwent renal puncture in Hangzhou hospital of traditional Chinese medicine from January 2015 to December 2020 were retrospectively analyzed.They were divided into middle-aged and elderly（≥ 45 years old）group and young（18～44 years old）group.The clinical,pathological and TCM syndrome characteristics of the two groups were compared.Results 1.A total of 103 patients were included,accounting for 28.37%of all MN patients during the same period,including 73 in the middle-aged and elderly group and 30 in the youth group.2.Compared with the young group,the middle-aged and elderly groups with hypertension,diabetes,and BUN were significantly increased（P<0.01）,and the eGFR and urine osmotic pressure values were lower than those in the control group（P<0.01）;3.In terms of renal pathology,the degree of glomerular sclerosis and chronic tubulointerstitial lesions in the middle-aged and elderly groups were higher than those in the control group（P<0.05）.4.Treatment and prognosis,multivariate ordinal logistic regression model showed age（OR=0.944,P=0.009）,urine protein quantification（OR=0.731,P<0.001）,serum creatinine（OR=0.962,P=0.023）And blood stasis syndrome（OR=9.694,P=0.002）is a factor that affects the remission of proteinuria in patients with AMN and is related to the prognosis.The complete remission rate in the middle-aged and elderly group was significantly lower than that in the young group（P<0.05）.5.TCM syndrome types:The main syndrome of TCM in the middle-aged and elderly group is the syndrome of qi and yin deficiency.Damp-heat syndrome is the most common TCM syndrome,among which the middle-aged and elderly groups have significantly more TCM syndromes than the young group.In the remission group,the syndrome of spleen-kidney qi deficiency combined with damp-heat syndrome and water-dampness syndrome was more common,while the unrelieved group mainly had qi-yin deficiency syndrome combined with blood stasis syndrome.Conclusions 1.The incidence of middle-aged and elderly AMN patients tends to increase.60%of the patients have proteinuria in the range of nephropathy and microscopic hematuria,and are prone to be accompanied by basic diseases such as hypertension and diabetes.2.Age,urine protein quantification,serum creatinine,and blood stasis syndrome are important factors that affect the remission of proteinuria and the prognosis of AMN patients.Middle-aged and elderly AMN patients have more severe renal pathology,more proteinuria,and higher serum creatinine than young AMN patients,and the prognosis is better.Young patients with AMN are worse.3.The most common TCM syndromes in the middle-aged and elderly group are qi and yin deficiency combined with damp-heat syndrome.The middle-aged and elderly group with blood stasis syndrome is significantly higher than the young group,and the clinical remission rate of AMN patients with blood stasis syndrome is the lowest.