| Objective:1. To analyze the distribution characteristics and change trend of pathological types in Shanxi Province for recent 20 years, the epidemiological features and clinicopathologic link of membranous nephropathy.2. To explore more reliable differential foundations through the analysis of the clinicopathologic features of 120 cases of MN.Methods:1. Describe the composition and changes of pathological types of renal biopsies in our nephrology pathology center in a case of 6858, performed between January 1996 and December 2015.2. Collected the clinical and pathological data of 120 MN patients in February 2015 to September, combined with IHC testing the expression of Ig G isoform and PLA2 R,evaluate their value in differential diagnosis.Results:1. During the past 20 years, a gradual increase in the annual number of renal biopsies,FGD was the predominant type in the case of 76.52%.Ig AN is the most frequent type(38.05%)of PGN, followed by MN(25.27%) 、 Ms PGN(17.70%). Compared to1996-2005, we observed a significant increases in the frequency of Ig AN and particularly MN and a significant decrease in the frequency of Ms PGN. 13.56% were SGD, with HSPN forming the most common lesion(52.04%) followed by LN(21.83%), diabetic nephropathy(10%), the relative frequency of DN as a cause of metabolic disorders increased to 13.50% from the 1996 to 2005 period. Detection rates of AMN rose but detection rate of IMN dropped, which is the main type of MN.Both of them were more males and various ages. Nephrotic syndrome was their predominant clinical presentation.2. A total of 120 patients were selected, which were examined by LM、IF、EM technique.69.17% were diagnosed IMN while 30.83%were AMN. The average age of AMN was younger than that in IMN. The difference was significant between AMN and IMN. There were no significant statistical differences in the level of 24-hours urinary protein excretion. A number of secondary processes can cause MN that is clinically and histologically similar to IMN, such as HBV、SLE、malignancy. IF positive rate of Ig A, Ig M, C3, FRA and C1 q in AMN were all higher than that in IMN. There were significant differences in IF positive rate of Ig A and Clq. The immunohistochemical staining showed that Ig G4 and PLA2 R tended to be highly expressed in IMN and their positive rate were significantly higher than that in AMN(P<0.05). The rate of Ig G1 and Ig G2 in AMN were higher than that in IMN. The rate of PLA2 R in IMN was higher than Ig G subtype, and significantly higher than that in AMN(P<0.05).Evaluated the value of Ig G4 and PLA2 R, their sensitivity were 79.5% and 90.4%respectively, the specificity were 59.5%and 35.1%,when the cut off point was 1.Integrated assessment Ig G4 and PLA2 R, the sensitivity was 71.1%and the specificity was 64.9 %. The features that characterize MN as a thickening of the GBM and effacement of the podocyte foot processes.Compared to IMN, electron-dense deposits in subepithelialand intramembranous position,and the additional matrix material laid down in AMN.Conclusion:1. The most common histological finding for primary glomerular disease following percutaneous kidney biopsy was Ig AN, HSPN was the commonest histological type in SGD. A significant increase in the frequency detection rates of MN. AMN rose but detection rate of IMN dropped, Both of them were more males and various ages.Nephrotic syndrome was their predominant clinical presentation. The development of pathological technical and carried out of CPC provide more reliable basis for the diagnosis and treatment of kidney disease.2. IMN is the predominate type of MN, a number of secondary processes can cause MN,that is clinically and histologically similar to IMN. Renal biopsy is still an important means of differential diagnosis of membranous nephropathy. The combination of Ig G4 and PLA2 R could also be helpful in differentiating IMN from AMN. |
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