| Object: 1. Through retrospective analysis of pathological diagnosis of type 2 diabetes mellitus(DM) combined with idiopathic membranous nephropathy(IMN) and diabetic nephropathy in North of China with clinical manifestations, pathological findings and auxiliary examination data, we summarize the general onset features,clinicopathologic characteristics and the clinicopathologic relationship, improving the understanding of diagnosis,differential diagnosis,therapy and prognosis of diabetic nephropathy(DN). 2. To discuss the role of serum anti-M-phospholipase A2 receptor(anti-PLA2R) antibody in the diagnosis and evaluate prognosis for DN combining our data with several published articles.Methods: 42 patients with DM combined with IMN, 66 patients with DN were involved proven by renal biopsy from February, 2002 to November 2015 in the Second Hospital of Jilin University. Clinical and pathological data were collected from all the enrolled patients. The data was analyzed by SPSS statistical method. In addition, morning fasting serum samples were collected from 15 cases with DM complicated with IMN and DN respectively, that selected from Jan 2014 to Nov 2015. Anti-PLA2 R antibody in serum was tested by ELISA. The positive rate of PLA2R-Ab and its correlation with proteinuria, disease activity and prognosis were analyzed.Results: 1. We selected 42 cases of diabetes mellitus combined with membranous nephropathy patients, 66 cases of patients with diabetic nephropathy From February 1, 2002 to November 30 2015. The progression of diabetic nephropathy in general is more than five years. Most of the patients were middle or old-aged male, among 66 cases of DN, there were 39 males and 27 females(male to female ratio was 1.4:1), mean age was 51.47±9.65 years old. The main patients with DN were elderlies, 45 years of age accounted for more than 81.82% of patients with diabetic nephropathy. The main diabetes mellitus patients with combined with membranous nephropathy patients were elderlies, 45 years of age accounted for more than 85.71% of patients with DM combined with IMN. The statistical analysis showed that diabetic patients with membranous nephropathy patients are mainly in elderly male patients. There was no statistical difference between the two groups.Two groups of patients with DM combined with IMN group and DN group, BMI were 27.16 + 3.69kg/ M2 25.49 + 3.44kg/ M2. Average weight of two groups were obese, but there were significant differences in two groups(p<0.05).2. The majority of diabetic patients with membranous nephropathy in diabetes for less than 5 years, which only accounted for 21.43% of the entire diabetic patients with membranous nephropathy. There were statistically significant differences between the two groups of DM complicated with IMN and DN. Compared with diabetic nephropathy group, diabetic retinopathy, renal insufficiency, hypertension and anemia were rare in the group of diabetic patients with membranous nephropathy, which is statistically significant differences between the two groups. In diabetic patients with membranous nephropathy group, patients manifested as nephrotic syndrome accounted for the very great proportion. There were statistically significant differences between the two groups of DM with IMN and DN.3. The two groups about diabetic patients with membranous nephropathy and diabetic nephropathy had statistical difference of laboratory indexes including hemoglobin, albumin, creatinine, triglyceride, cholesterol and 24-hour urinary protein. Fasting blood glucose, glycosylated hemoglobin, hematuria ratio was not statistically significant.4. As immunofluorescence pattern, there were statistical differences in Ig M, Ig G and C3 expression between the two groups of patients and no significant differences in Ig A, C4, C1 q and Fib expression. In DM with IMN, the rate of Ig G expression was as high as 97.97%, and the rate of Ig G expression in DN patients was only 22.22%. Compared with the DM with IMN, the expression of C3 in diabetic nephropathy was also significantly reduced. The expression of Ig M in DN group was more than in the group of DM with IMN. In the group of DM with IMN, stage of I and I-II were the most common pathological type, accounting for 81.25% of the entire group of membranous nephropathy.5. 15 patients in two groups were selected respectively and serum anti PLA2 R antibody was detected by ELISA method. In the group of DM with IMN, the serum anti PLA2 R antibody was positive in 9 cases, negative in 6 cases, the positive rate was 60%. The serum anti PLA2 R antibody in patients with DN was negative.Conclusion:1. This research pointed out that diabetes clinic history was more than five years for most of the patients in DN group followed by hypertension, renal insufficiency and anemia etc. When the renal damage in patients with diabetes mellitus, no diabetic retinopathy, no renal insufficiency in nephrotic syndrome, it can be considered NDRD. Renal biopsy should be recommended for this group of patients, in order to clear the pathological diagnosis and treatment.2. Most of the patients were middle or old-aged male in the group of DM with IMN, nephrotic syndrome was commonly seen as clinical features in these patients. Pathological pattern in stage I and I–II was larger proportion, and stage I was the most common type. Ig G and C3 expression increased in patients with DM combined with IMN compared with in the DN group, the difference was statistically significant. Expression of Ig M in the DN with IMN group decreased than in DN group, the difference was statistically significant.3. In this study, positive rate of serum anti-PLA2 R antibody was 60% in the group of DM with IMN. The serum levels of PLA2R-Ab in DM with IMN patients was positively correlated with 24-hour urinary protein, was negatively correlated with serum albumin. Anti PLA2 R antibody in serum of patients in DN group was negative. |
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