| BackgroundIdiopathic membranous nephropathy (IMN) is responsible for most cases of nephrotic syndrome in adults. Although the detailed pathogenesis of membranous nephropathy is unknown, specialised staining techniques of renal biopsies show that the immune system is involved. Although spontaneous remission may occur in some cases and several therapeutic options are now available, in20-30%of patients the response to therapy is poor and the risk of kidney disease progression remains high. With the improvement of renal biopsy technology and pathologic examination means, the detection rate of IMN in our country was also improved. But Domestic large-scale research in this field is famine. The related research of clinical and pathological diagnosis index or prognostic indicator in our country is also famine. The related research of clinical and pathological diagnosis index or prognostic indicator in our country is also famine. The researches of this field are very helpful for the early diagnosis and early treatment of IMN. So in our research, we approached from three aspects:the epidemiologic data of IMN from a single unit (the nephrology department of PUMCH); clinical and pathological diagnosis index of IMN and the prognostic indicator of IMN.Objectives(1) To study the alteration of epidemiologic data of IMN from2001to2011in our hospital(2) To study the difference of IMN and LMN in glomerular IgG subclasses deposition and serum IgG subclasses concentrations.(3) To find a prognostic indicator of IMNMethodsPart1The study of the alteration of epidemiologic data of IMN from2001to2011in our hospitalCase selection:the patients undergoing renal biopsy in PUMCH between2001and2011, the pathological diagnose of IMN is clear.(1) We collected the total renal biopsy cases during the period of2001to2011from PUMCH, and analyzed the sex ratio and median age of these renal biopsy cases each year.(2) Analyze the incidence of IMN in total renal biopsy cases of PUMCH each year; the IMN/secondary membranous nephropathy (SMN) ratio; the clinical feature and pathologic stage (PS) distribution of IMN patients.(3) group in biopsy time:2005years ago,2006-2007,2008-2009and2010-2011. Stratified by age:<30y,30-60y,>60y, to see if there was some difference by year.Part2The study of the difference of IMN and LMN in qlomerular IqG subclasses deposition and serum IqG subclasses concentrations.Case selection:the patients undergoing renal biopsy in PUMCH between Oct2011to May2012, with the clinical feature of nephrotic syndrome (NS) or chronic glomerulonephritis (CGN). Group:IMN (n=90), LMN (n=19).(1) We compared the clinical data and manifestations of these two groups.(2) By immunofluorescence staining, we analyzed the intensity of glomerular IgG subclasses between two groups semi-quantitatively.(3) To part of patients of these two groups, we analyzed their serum IgG subclasses concentrations quantitatively.Part3the study of prognostic indicators of IMNCase selection:the patients undergoing renal biopsy in PUMCH between2004and2007, the pathological diagnose of IMN is clear and followed for>3years from the time of diagnosis.(1) review the clinical manifestations and pathological features of these patients.(2) review the kidney pathological section of all patients, calculate the renal cortical area and the non-sclerotic glomerular number, calculate the glomerular density(GD).(3) group these patients by GD, analyze the prognosis of two group.(4) group by prognosis, analyze the passible influencing factors between these two group.Results(1) The incidence of IMN in total renal biopsy cases of PUMCH each year is gradually increased, in2011, the incidence even close to20%. the IMN/SMN ratio each year is also increased. And the patient with pathologic staging of Ⅰ-Ⅱ stage is significantly increased by years. But the result of stratified analysis by age has no significant difference.(2) The mean age of IMN is49±14years and female/male ratio (F/M) is0.53:1; in LMN is33±16years and2.8:1(F/M). The mean age has significantly difference between two groups, as well as F/M ratio between two groups. Proteinuria or serum albumin has no difference between two groups. The serum creatinine (Scr) of IMN group is lower than LMN group (71.99126.01vs84.37±38.02ml/min/1.73m2, P=0.006).(3) The intensity of lgG4staining and percentage of lgG4predominance in IMN glomeruli are both higher than LMN group (1.8410.72vs0.82±0.87;82.2%vs31.6%, respectively; P<0.001). The serum lgG4concentration and serum lgG4/lgG ratio in IMN group are both higher than LN group (0.36±0.30vs0.19±0.24;5.8±3.9vs1.8±1.8, respectively; P<0.05).(4) group the patients who followed more than3years by prognosis, the HTN patien proportion in non-improving group is higher than improving group (85.7%vs36%, P=0.033). By logistic regression analysis, pathologic stage is one of the predictor for poor long term prognosis of IMN (P=0.020). the mean GD of non-improving group is lower than improving group, but without Statistical differences(2.503±1.160/mm2vs3.440±1.118/mm2, P=0.058)Conclusions(1) The incidence of IMN in total renal biopsy cases of PUMCH each year is increasing.(2) The glomerular lgG4deposit and high serum lgG4/lgG is helpful to identify IMN and LMN.(3) HTN is one of the influencing factors of IMN prognosis.(4) Pathologic stage is one of the predictor for poor long term prognosis of IMN(5) Low glomerular density is a possible risk factor of disease progression. |
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