Clinicopathological Characters And Prognosis Of The Membranous Nephropathy Companied With IgA Nephropathy

Background Idiopathic membranous nephropathy is a common pathological type of primary kidney disease in elderly patients and is mediated by immune complex diseases.The light microscope is mainly characterized by glomerular subepithelial deposition of addicted to complex red protein along with the thickening of the basement membrane,Ig G and C3 are the dominant immune complexes which deposited on the capillaries wall based on immunofluorescence,the characteristics of Electron microscopy is the glomerular subepithelial deposition of electron-dense complex and the fossa fusion of the glomerular podocytes.The main clinical manifestations of the Idiopathic membranous nephropathy are massive proteinuria,with or without hypoalbuminemia;Studies have shown that 13% ~ 55% of patients have hypertension,30% ~ 50% of patients present with microscopic haematuria,but rare patients show gross haematuria.IgA nephropathy is the most common primary glomerular disease in our country,occurs at any age mainly in teenagers.The disease is characterized by a predominant deposition of IgA-containing immune complexes in the glomerular mesangium.The main clinical manifestation of the IgA nephropathy is asymptomatic microscopic hematuria and 40% of patients had recurrent macroscopic haematuria.These two diseases are mediated by immune complex and the pathogenesis is different,so the same patients suffering from both these two diseases are rare.Literatures of the domestic and foreign about the patients of the Membranous nephropathy with IgA nephropathy are few,Give priority to with case.The reports about the merger observed the clinical pathological characteristics and treatment outcomes of the patients lack corresponding research.Therefore,This study by comparing membranous nephropathy with IgA nephropathy and pure idiopathic membranous nephropathy in clinical pathological characteristics and outcomes of treatment is to explore the clinical characteristics and treatment outcomes of the Membranous nephropathy with IgA nephropathy.Objective to explore the clinicopathological characteristics and prognosis of the membranous nephropathy companied with lg A nephropathy patients.Methods Twenty-eight patients with membranous nephropathy companied with lg A nephropathy were severd as disease group and twenty-eight patients with idiopathic membranous nephropathy were severd as control group.Patients were from The Affiliated Hospital of Zhengzhou University between October 2014 and February 2016.The general informations were collected which including age,sex,the onset time of disease,blood pressure,gross hematuria.The laboratory indicators were collected which including Proteinuria of 24-hour,serum albumin,serum creatinine,serum triglyceride,serum cholesterol,anti-PLA2 antibody level,estimated glomerular filtration rate;The renal pathology were collected which including Renal pathology structure and Immune complex deposition.The treatment was as the treatment program of idiopathic membranous nephropathy.The follow-up time was range six to twenty-six months,all patients were followed up according to endpoints,which referred to the complete remission of kidney disease.Then we analyzed the clinical and pathological characteristics as well as the prognosis between the patients of the two groups.Results 1.Patients of the idiopathic membranous nephropathy companied with IgA nephropathy patients were the elderly,often presented with nephrotic syndrome with microscopic hematuria.Males patients were more than females patients.2.Compared with the control group,the differences were not statistically significant between the two groups in the age of onset,duration,the rate of presented hypertension,serum creatinine,triglyceride levels and Estimated GFR(P>0.05).3.Compared with the control group,the levls of the 24 hours urinary total protein quantitation serum,anti-phospholipase A2 receptor(PLA2R)antibody levels and serum albumin were statistically lower in the disease group(P < 0.05),but the levls of the Albumin and the rate of presented hematuria was statistically greater in the disease group(P < 0.05).4.The pathological characteristics were the same except that deposition of IgA-containing immune complexes in the glomerular mesangium and the increasion of the mesangial cells and matrix.5.By Kaplan-Meier survival analysis,as the time of kidney disease achieving complete response is the reaction time.The reaction time was not statistically significant whether the patients of Membranous nephropathy with IgA nephropathy had hematuria(P>0.05).But the reaction time of the disease group was statistically shorter than the control group(P<0.001).Conclusions 1.Patients of the idiopathic membranous nephropathy companied with IgA nephropathy patients were the elderly,often presented with nephrotic syndrome and microscopic hematuria.Males patients were more than females patients.2.The clinicopathological characteristics and pathological manifestations of the idiopathic membranous nephropathy companied with lg A nephropathy had the characteristic of the Idiopathic membranous nephropathy and IgA nephropathy;and it was not severe as idiopathic membranous nephropathy patients by immunosuppressive therapy,and the prognosis was better than pure idiopathic membranous nephropathy.