Clinical Analysis Of121Cases Of Membranous Nephropathy And Retrospective Analysis Of Treatment Effect Of58Cases

Objective1. Review and analyze the clinical data of patients diagnosed with idiopathic membranous nephropathy or atypical membranous nephropathy in Guangdong Provincial Hospital of TCM, to summarize the occurrence regularity, clinical features and relations of the two.2. Retrospectively analyze efficacy of patients with membranous nephropathy treated by Integrative Medicine, to provide effective treatment options for membranous nephropathy.Methods1. Clinical data of121hospitalized patients from January2011to December2013were collected. All the121patients were performed renal biopsy guided by ultrasound.90cases were diagnosed with idiopathic membranous nephropathy and31cases with atypical membranous nephropathy (without definite secondary factors). They had complete clinical and pathological data and laboratory test. SPSS17.0software was used to establish the database and to do statistical analysis.2. Of the121patients with membranous nephropathy,58cases with complete inpatient and outpatient follow-up data from January2011to June2013were collected to retrospectively analyze their therapeutic efficacy by SPSS17.0. Results1. Gender:Of the90cases with idiopathic membranous nephropathy, the gender composition was38male and52female (42.2%vs57.8%);of the31cases with atypical membranous nephropathy,14cases were male and17cases were female (45.2%vs54.8%). There was no gender statistical significance between the two groups.2. Age:90cases with idiopathic membranous nephropathy were18to79years old, mean age was52.11±15.07;31cases with atypical membranous nephropathy were15to68years old, mean age was39.68±17.16; There was significant difference between the two groups (P<0.01)3. Clinical onset manifestation:In the idiopathic membranous nephropathy group,72cases (80%) were presented with nephrotic syndrome and18cases were presented with chronic nephritic syndrome. And in the atypical membranous nephropathy group,26cases (83.9%) with nephritic syndrome,5cases (16.1%) with chronic nephritic syndrome. There was no significance between the two groups.4. Immune disorder:51cases (56.7%) were presented with immune disorders [including chronic inflammation of mucous membranes and skin, allergic diseases, chronic infections (with hepatitis B virus surface antigen positive in serum while negative in renal tissue), pregnancy, etc.) in the idiopathic membranous nephropathy group and17cases (54.9%) in the atypical membranous nephropathy group. The difference was not statistically significant.5. Pathological staging:Among the idiopathic membranous nephropathy group,18cases (20%) were at stage Ⅰ,6cases (6.7%) were at stage Ⅰ-Ⅱ,62cases (68.9%) were at stage Ⅱ,3cases (3.3%) were at stage Ⅱ-Ⅲ and1cases (1.1%) were at stage Ⅲ.6. Related laboratory test:The24h urinary protein excretion was4381±3150mg in the idiopathic membranous nephropathy group and5821±3214mg in the atypical membranous nephropathy group, the difference was significantly different (P<0.05).There were no statistical difference between the two groups in serum creatinine, albumin, gromerular filtration rate, cholesterol, triglycerides, fibrinogen, immunoglobulin G and complement C3.7. TCM diagnosis and syndrome differentiation:In the idiopathic membranous nephropathy group,76cases (84.4%) were diagnosed with edema in TCM and11cases(12.2%) with turbid urine. While in the atypical membranous nephropathy group,26cases (83.9%) were diagnosed with edema,5cases (16.1%) with turbid urine. There was no statistical difference between the two groups.8. Of the121patients,58cases accepted Integrative Medicine treatment for6months, collected from January2011to June2013. Of the34cases in the idiopathic membranous group,9cases(26.5%) reached complete remission,14cases(41.2%) partial remission,10cases(29.4%) without response, and1case(2.9%) died. Similarly in the atypical membranous nephropathy group,7 cases(29.2%) reached complete remission,8cases(33.3%) partial remission,7cases(29.2%) without response, and2case(8.3%) died. The total remission rate in the both groups was67.7%and62.5%respectively with no statistical difference. The total remission rate of medium risk group was81.8%and73.3%respectively in idiopathic membranous nephropathy and atypical membranous nephropathy. Conclusions:1. Patients with idiopathic membranous nephropathy or atypical membranous nephropathy admitted in our nephrology department were mostly women, different with previous literature report. The peak incidence age of idiopathic membranous nephropathy was50to70years old, while in the atypical membranous nephropathy was20to40years old.2. Of patients with idiopathic membranous nephropathy, pathological stage II takes majority(68.9%), followed by stage Ⅰ (20%).3. Immune disorders existed in more than half of the patients with idiopathic membranous nephropathy or atypical membranous nephropathy, suggesting that the incidence of membranous nephropathy may be correlated with immune disorders.4. Although the clinical manifestation and therapeutic reaction of idiopathic or atypical membranous nephropathy were similar, atypical membranous nephropathy had its own characteristics and should be followed up for a long time.5. The majority TCM diagnosis of both idiopathic and atypical membranous nephropathy was edema and turbid urine. The basic syndrome differentiation was Qi deficiency of spleen and kidney and deficiency of both vital energy and yin. During the process, internal water retention, dampness, humid heat and blood stasis were also existed.6. Integrative Medicine therapy is an effective intervention for treating membranous nephropathy and is worth to be used in clinical practice. To patients in medium risk group, glucocorticoids and glucosidorum tripterygll totorum therapy based on conservative treatment is effective to improve the response rate.