Analysis Of Clinical Pathologic Data In Adults Of Idiopathic Membranous Nephropathy With Decreased Renal Function And Nephrotic-range Proteinuria

Objective:TO explore the the clinical and pathological data in adults of idiopathic membranous nephropathy(IMN)with decreased renal function and nephrotic-range proteinuria,and find the relationship between clinical manifestation and pathology,possible link between e GFR and amount of urine protein,and provide reference for clinical diagnosis and treatment.Methods:This study included initial diagnosis patients with IMN that underwent renal biopsies at our hospital,during the period from January 2006 to December 2016.According to the estimated glomerular filtration rate(e GFR)of the patients were divided into normal renal function group(e GFR = 90ml/min/1.73cm2)and decreased renal function group(e GFR < 90ml/min/1.73cm2),at the same time according to the existence of nephrotic range proteinuria(more than 3.5g/d)of the patients were divided into nephrotic-range proteinuria group(urine protein more than 3.5g/d)and non nephrotic-range proteinuria group(proteinuria < 3.5g/d),comparative analysis of clinical and pathological data of the four groups of patients.Result: 1.The study include 140 cases,96 cases of men,and women in 44 cases,proportion of male patients is higher,the sex ratio of 2.18:1.IMN patients with an average age of 48.79 ±13.15 years old,about 38.60% of nephrotic syndrome,decreased renal function 54.29%,89.20% in microscopic haematuria,49.60% of high blood pressure,anemia in 33.60%,38.60% of hyperuricemia.IMN mainly composed by?and?pathological stage.?stage of IMN has 84 cases,accounting for 60.00% of the total,?stage of IMN has 34 cases,accounting for 24.30% of the total,? stage of IMN has 20 patients,accounted for 14.30% of the total,stage of ? IMN has 2,accounted for 1.40%.2.The decreased renal function group has 76 patients,Compared with the patients who normal renal function,the incidence of decreased renal function group is differenct in age and sex(mainly in the elderly and male),and the difference was statistically significant(P<0.01).The patients with decreased renal function group have higher rate of complicated with hypertension,anemia,hyperuricemia,the difference is statistically significant(P < 0.05).decreased renal function group with more serious glomerulus sclerosis ? renal tubular atrophy,and renal interstitial lesions,the difference is statistically significant(P < 0.05).There was no significant difference between the two groups in renal arteriolar lesion and crescent formation(P > 0.05).3.The patients who up to nephrotic-range proteinuria have 57 cases.Compared with patients who did not reach nephrotic-range proteinuria,The patients up to the level of nephrotic syndrome proteinuria have higher rate of hypoalbuminemia and hypertriglyceridemias,the difference is statistically significant(P < 0.05),lower rate of glomerulus sclerosis,the difference is statistically significant(P< 0.05).And there was no significant difference in renal tubular atrophy?renal interstitial lesions?renal arteriolar lesion and crescent formation(P > 0.05).4.According to the e GFR and the amount of urine protein level,patients were divided into 4 groups,normal renal function and non nephrotic-range proteinuria patients(group A,40 cases),normal renal function and nephrotic-range proteinuria patients(group B,24 cases),decreased renal function and non nephrotic-range proteinuria patients(group C,43 cases),decreased renal function group and nephrotic-range proteinuria patients(group D,33 cases).Group D has higher rate than group A in the proportion of men?aged?the proportion of hypertension,the proportion of hypoalbuminemia and the proportion of hyperuricemia(P < 0.05).Group D has longer uration of disease than group B,has higher rate in the proportion of anemia and the proportion of tubular atrophy(P < 0.05).Group D has higher rate in hypoalbuminemia than group C,has lower rate in glomerulus sclerosis than group C(P < 0.05).Group C has higher rate than group A in male proportion?gerontism?hypertension,group C hypertension ratio greater than group B,group C has higer rate in glomerulus sclerosis rate than group A?B?D,group C has higer rate in renal interstitial lesion than group A and group B(P < 0.05).Group B has higher rate in The proportion of hypoalbuminemia than group A,Group B has higher rate in The proportion of hypoalbuminemia than group C(P < 0.05).Conclusion:IMN patients with decreased renal function group have higher rate of hypertension?anemia?hyperuricemia,and appears more glomerulus sclerosis,renal tubular atrophy,renal interstitial lesions;The patients who up to the level of nephrotic syndrome proteinuria do not appear significantly renal tubular atrophy,renal interstitial lesions,on the contrary,glomerulus sclerosis rate is lower.The decreased renal function and nephrotic-range proteinuria patients is mainly composed of men and gerontism,and have higher rate of hypertension,hypoalbuminemia,hyperuricemia,and the patients have longer uration of disease,higher rate of anemia?renal tubular atrophy than the patients who only reach nephrotic level proteinuria patients.The decreased renal function and nephrotic-range proteinuria patients have higer rate in hypoalbuminemia than the patients who only have decreased renal function,but have lower rate in glomerulus sclerosis than the patient who only have decreased renal function.