Clinical And Pathological Analysis Of Idiopathic Membranous Nephropathy In80Adult Cases

Background and Objective:One of the common cases of nephrotic syndrome in adults is idiopathicmembranous nephropathy, which is an antibody-mediatded autoimmune glomerulardisease. Currently, the pathogenesis of IMN has not been completely clear. IMN hasan unpredictable natural history, its clinical manifestations and prognosises arevarious. In some cases IMN spontaneous remission may happen, however, there arestill many patients with poor therapeutic effects and side effects of drugs remain high.At present, the treatment options of IMN patients have been heavily debated.Therefore, it is crucial to early identify IMN patients at high risk through clinical andpathological indexes, which can also reduce additional costs of treatment and sideeffects of drugs among those IMN patients at low risk. In our research, we expected toearly identify IMN patients at high risk in order to give them appropriate treatment intime, protect renal function and delay the progression of the disease through theanalysis of the clinicopathological features of80adult IMN cases.Methods:A number of80patients of renal biopsy-proven IMN in the first hospital of Jilinuniversity department II from September2012to September2014were involved.Retrospectively analyzed the general information, clinical manifestations, laboratoryindexes and renal pathological results of those patients on the basis of gender(male,female) and the level of GFR respectively. All patients were followed up bytelephones or out-patient review for six months to track of and compare differenttreatment groups’ clinical remission.Results:1)80IMN cases were involved, which accounted for11.69%of renalbiopsy-proven primary glomerular nephritis during the same period. Middle-aged andelderly people were inclined to IMN and the average age was(52.01±10.93)years oldwith male and female prevalence ratio of2.08:1. All the cases were associated with proteinuria,63cases had the clinical manifestations of NS which accounted for78.8%,17cases were associated with non-nephrotic proteinuria which accounted for21.2%.No cases were found with macroscopic hematuria, while74cases were accompaniedby microscopic hematuria which accounted for92.5%.77cases had the clinicalmanifestations of edema, which accounted for96.3%.42cases had the clinicalmanifestations of hypertension which accounted for52.5%. About52.5%of the totalpatients, there was42cases, had GFR≥90ml/min, while29cases had60ml/min＜GFR＜90ml/min which accounted for36.3%,9cases had GFR≤60ml/min whichaccounted for11.3%.2) About68.8%of the patients’ renal biopsy pathological types were classified asstage I-II, while stage III were rare(12.5%), stage IV were not seen among those cases.When renal biopsy tissues were examinated by immunofluorescence, depositions ofIgG and C3were mainly found, respectively accounted for98.8%and95%, while35%of them with IgA deposition,33.8%of them with IgM deposition. Thedepositions of C4, C1q and FAR were rare, which respectively accounted for27.5%,23.8%and12.5%. Renal biopsy pathology of those cases were accompanied byglomerulosclerosis(67.5%), by FSGS(21.25%), by tubulointerstitial lesions(88.8%),by small artery lesions(72.5%), by mesangial proliferation(90%), and3.8%of themappeared crescent.3) Grouping by gender: Compared with female patients, male patients had higherproportions of NS and hypertension, higher levels of SBP,24h urine protein, BUN,Scr, TC and HGB, while lower levels of TP, ALB, IgG and IgM. The differencesbetween two groups above were statistically significant. The proportion of edema, theproportion of microscopic hematuria and levels of DBP, age, course of disease beforerenal biopsy, GFR, UA, TG, LDL, HDL, IgA, C3, C4between two groups had nostatistically significant differences. The differences of pathological types, proportionsof being accompanied by glomerulosclerosis, FSGS, mesangial proliferation, crescent,tubulointerstitial lesions, small artery lesions under microscopes, the deposition ofantibodies and complements by immunofluorescence examination between twogroups were not statistically significant.4) Grouping by the level of GFR: With the decline of GFR level, IMN patients’proportion of hypertension, levels of SBP, DBP, age, BUN, Scr and TC became higher,while levels of ALB and HGB became lower. Results of linear correlation and regression analysis between the level of GFR and each index showed that HGB havethe positive correlation with GFR and age, SBP, DBP, TC have negative correlationswith GFR. That is to say, elderly patients, or patients with poorly controlledhypertension, severe anemia, higher level of TC were inclined to have renal failure.The comparison of pathological types among these groups showed that the group of“GFR≤60ml/min” have a higher proportion of stage II than the group of “GFR≥90ml/min” and the difference is statistically significant, while there are no siginificantdiferences in other pathological types. The comparison of pathological featuresshowed that patients with lower level of GFR have a higher proportion of FSGS undermicroscopes, while the proportions of being accompanied by glomerulosclerosis,mesangial proliferation, crescent, tubulointerstitial lesions, small artery lesions undermicroscopes and the deposition of antibodies and complements byimmunofluorescence examination have no siginificant differences.5)67IMN cases had completed6months’ follow-up and the clinical remissionrate of19cases with the treatment of glucocorticoid combined withcyclophosphamide was78.9%, while the clinical remission rate of45cases with thetreatment of glucocorticoid combined with cyclosporine A was86.7%. The differenceabove was not statistically significant. The other3cases treated with glucocorticoidonly had not obtained clinical remission.Conclusions:1)80cases of idiopathic membranous nephropathy are inclined to middle-agedand elderly people, and male groups have a relatively higher prevalence. Renalpathological types of those cases were given priority to stage I-II. Theimmunofluorescence examination shows that depositions of IgG and C3are mainlyfound, some cases may be accompanied by IgA, IgM deposition, while depositions ofC4, C1q, FAR are rare.2) Of80IMN cases, Male patients have relatively severe clinical manifestationsand gender-male is a significant risk factor of disease progression; Elderly,accompanied by focal segmental glomerulosclerosis, poorly controlled hypertension,high level of total cholesterol and severe anemia are risk factors for the decline ofrenal function for idiopathic membranous nephropathy patients.3) Glucocorticoid combined with cyclosporine A and glucocorticoid combinedwith cyclophosphamide are major treatments for80IMN patients, there were no significant differences between them in the remission rate after6months treatment.