Relationship Between Tubulointerstitial Lesions And Clinical Pathology And Prognosis In Patients With Idiopathic Membranous Nephropathy

Objective To compare the clinicopathologic,therapeutic and prognostic differences in patients with idiopathic membranous nephropathy(IMN)with or without tubulointerstitial(TIN)lesions.To investigate the effect of TIN lesions on the prognosis of IMN patients.Methods This was a single-center retrospective longitudinal observational study.The clinical and pathological data of 582 patients with IMN were retrospectively analyzed.The patients were divided into non-TIN group(n = 258)and TIN group(n = 324)according to the presence or absence of TIN lesions.The clinicopathologic and follow-up data were collected.Univariate and multivariate logistic regression analysis were used to compare the clinical and pathological characteristics of the two groups.Kaplan-Meier survival curves(log-rank test)were used to analyze the effect of TIN lesions on renal function survival and renal prognosis,and univariate and multivariate Cox regression were used to analyze the influencing factors of renal prognosis in IMN patients.Results1.Compared with patients without TIN lesions,the majority of patients in the TIN lesion group were male,older,had a higher proportion of smoking,a higher mean systolic blood pressure,mean diastolic blood pressure,and mean arterial pressure,a higher proportion of patients with hypertension,hyperlipidemia,and nephrotic syndrome,a higher proportion of patients receiving immunosuppressive therapy,a higher proportion of microscopic hematuria,triglycerides,blood urea nitrogen,serum creatinine,and 24-hour urinary protein quantification,a lower albumin(ALB)and estimated glomerular filtration rate,a higher pathological stage,and more severe glomerulosclerosis(glomerulosclerosis/segmental sclerosis)and renal arteriolar intimal thickening lesions,and the differences were statistically significant(P < 0.05).2.Multivariate logistic regression analysis showed that hypertension,glomerulosclerosis(glomerulosclerosis/segmental sclerosis),renal arteriolar intimal thickening,and ALB were the influencing factors of TIN lesions in IMN patients.3.After 6 months of initial treatment,IMN patients with TIN lesions had a lower disease remission rate compared with IMN patients without TIN lesions.After a median follow-up of 45 months,Kaplan-Meier survival curves showed that TIN lesions had a worse renal prognosis.Univariate and multivariate Cox regression analysis showed that TIN lesions,hypertension,and high-density lipoprotein cholesterol were factors influencing the poor renal prognosis of IMN patients.Conclusion TIN lesions are frequent in pathological lesions of IMN patients.Patients with TIN had more severe baseline clinical manifestations,more complications,more severe renal histopathology,and relatively worse renal function,of which hypertension,glomerulosclerosis(glomerulosclerosis/ segmental sclerosis),and renal arteriolar intimal thickening were independent risk factors for TIN lesions,and ALB was an independent protective factor for delaying TIN lesions;after 6 months of initial treatment,IMN patients with TIN lesions had a lower disease remission rate and were more difficult to achieve clinical remission.IMN patients with TIN lesions had an earlier time to poor renal prognosis and a worse renal prognosis.TIN lesions and hypertension were independent risk factors for poor renal prognosis in IMN patients,while high-density lipoprotein cholesterol were independent protective factors.