Prognostic Factors Of Idiopathic Membranous Nephropathy Treated With ACEI/ARB Alone

Objective:To assess the prognosis and influencing factors of idiopathic membranous nephropathy(IMN)treated with ACEI/ARB alone.Methods: 85 IMN patients diagnosed by renal biopsy in Nephrology Department of Shengjing Hospital affiliated to China Medical University from Dec 2011 to Dec 2016 were enrolled in the study.All the patients were treated with ACEI or ARB alone and followed up for at least 6 months.According to the therapeutic response,patients were divided into two groups,remission group and no remission group.The difference of basic information,biochemical indexes,and pathological results was analyzed by single factor correlation and logistic regression analysis in order to evaluate the possible prognostic influencing factors.Results: All patients were followed up for 6-53 months,with an average of(17.39±11.10)months.At the end of the follow-up,39 patients were in no remission group(45.88%)and followed up for 6-36 months(11.44±7.42months).Remission often occurred 6-18 months after using ACEI/ARB alone.Compared with remission group,the proportion of patients over 60 years of age or patients with diabetes was higher in no remission group.The patients in no remission group were with lower glomerular filtration rate,higher serum cystatin C,more severe renal tubular interstitial infiltration of inflammatory cells,and more serious degree of glomerular capillary loop C3 deposition.Further regression analysis showed that diabetes and higher serum cystatin C were independent risk factors affecting treatment response.Conclusion: Treatment with ACEI/ARB alone can relieve part of IMN patients.Past diabetes history and higher serum cystatin C may affect the treatment response of patients.Individualized treatment should be selected according to patients' condition.