Clinical Features And Traditional Chinese Medicine Syndromes Of Idiopathic Membranous Nephropathy

ObjectiveTo investigate the general characteristics,clinical and pathological features,and the distribution of TCM syndromes in patients with idiopathic membranous nephropathy in Guangdong,and to explore the correlation between age,clinical indexes and pathological features of idiopathic membranous nephropathy and TCM syndromes.To provide a theoretical basis for the rational diagnosis and treatment of membranous nephropathy and to judge the prognosis of the disease,and to give full play to the advantages of traditional Chinese medicine in the treatment of the disease.MethodsA total of 433 cases of IMN confirmed by renal biopsy in outpatient and ward of Kidney Center of Guangdong Provincial Hospital of Chinese Medicine Hospital from February 2011 to February 2018 were collected.The patients'complete history,TCM syndromes,treatment general situation,clinical and pathological data were retrospectively studied,and the statistics were analyzed by SPSS17.0 software.According to sex,age,hyperuricemia,whether to use immunosuppression treatment,hypertension and renal function level were grouped to compare their clinical,pathological characteristics and the correlation of TCM syndrome type.Results1.Of the 433 patients with IMN,the ratio of male to female was 1.38:1.The age was 51.60±14.87 years old.The time from onset to renal biopsy was10.00±20.49 months.The 24 hours urine protein quantification was 5.23±3.50 g,and serum albumin 24.90±6.64 g/L.Nephrotic syndrome were 248(57.3%).Hematuria were 192 cases(44.3%).There were 254 cases with hypertension(58.7%)and 244 cases with hyperuricemia(56.4%).The eGFR<60 ml/(min·1.73m~2)were involved in 86 cases(19.9%).2.Compared with the female group,the clinical manifestations of the male group were as follows:24 hours proteinuria,creatinine,urea nitrogen,serum uric acid,triglyceride,hemoglobin levelserum albumin and eGFR level were higher in the male group than in the female group.The difference was statistically significant(P<0.05),and the scores of glomerular global sclerosis,glomerular segmental sclerosis and tubulointerstitial lesion were higher in male than in female(P<0.05).3.The incidence of nephrotic syndrome in the middle and old age group was higher than that in the young group.The level of triglyceride in middle-aged group was higher than that in young group.With age,the incidence of hypertension,serum creatinine,urea nitrogen and blood uric acid gradually increased,while serum albumin,hemoglobin,and eGFR levels declined.The older,the more serious the glomerular sclerosis and the tubulointerstitial lesion.The incidence of renal arteriopathy in middle age group was higher than that in young group.4.The serum albumin level of IMN patients with hyperuricemia is higher than that of IMN patients with normal uric acid level,eGFR level is relatively low,and the score of tubulointerstitial disease is higher.The difference is statistically significant(P<0.05).5.Compared with the non-immunosuppression treatment group,the ratio of male to immunosuppression treatment was more,nephrotic syndrome,higher incidence of hypertension,higher urinary protein,serum albumin,hemoglobin,global sclerosis of glomerulus and higher degree of segmental sclerosis.The difference is statistically significant(P<0.05).6.The age,course and incidence of nephrotic syndrome in hypertension group were significantly higher than those in normal blood pressure group(P<0.01),and the levels of urinary protein,serum creatinine,urea nitrogen and triglyceride were significantly higher than those in normal blood pressure group(P<0.01).The scores of glomerular global sclerosis,segmental sclerosis and tubulointerstitial lesion were higher in patients with hypertensive IMN than in normal blood pressure group(P<0.05).Multivariate logistic regression analysis showed that there was a correlation between age and 24h urinary protein quantification.7.Compared with normal renal function group,the proportion of males,age,incidence of nephrotic syndrome,incidence of hyperuricemia,incidence of hypertension,systolic blood pressure,diastolic blood pressure,24 hours urinary protein quantification,serum creatinine,and serum nitrogen were measured.The levels of urea nitrogen and triglyceride were higher than those of serum albumin and hemoglobin.The scores of glomerular global sclerosis,segmental sclerosis and tubulointerstitial lesion were significantly higher in the group of renal function decline than in the group of normal renal function.By multivariate logistic regression analysis,renal function decline was associated with age,serum uric acid,albumin,global glomerulosclerosis score and tubulointerstitial injury score.8.The main diagnosis of TCM was edema in 309 cases(71.4%),and and the deficiency of asthenia syndrome of spleen and kidney was the most common syndrome,207 cases(47.8%),followed by spleen and kidney deficiency,163cases(37.6%),Qi Yin two deficiency syndrome 41 cases(9.5%),lung kidney qi deficiency syndrome 13 cases(3%),liver kidney yin deficiency syndrome9 cases(2.1%).In the youth group(14~40 years old),44 cases(10.2%)were mainly spleen and kidney qi deficiency,followed by spleen and kidney yang deficiency in 33 cases(7.6%),Qi Yin two deficiency syndrome in 12 cases(2.8%),lung kidney qi deficiency syndrome 6 cases(1.4%),liver kidney yin deficiency syndrome 3 cases(0.7%).In the middle aged group(41~64 years old),there were 130 cases with deficiency of spleen and kidney yang(30%),followed by92 cases with deficiency of spleen and kidney Qi(21.1%),22 cases with deficiency of qi and yin(5.1%),6 cases with deficiency of lung and kidney qi(1.4%)and 4 cases with liver and kidney yin deficiency syndrome(0.9%).In the elderly group(?65 years old),the majority was deficiency of spleen and kidney yang,44 cases(10.2%),followed by deficiency of spleen and kidney Qi deficiency(27 cases,6.2%),Qi and yin deficiency syndrome(7 cases,1.6%),liver and kidney yin deficiency syndrome(2 cases,0.5%)and lung and kidney qi deficiency syndrome(1 case,0.2%).9.The age of spleen and kidney yang deficiency is higher than that of lung and kidney qi deficiency,spleen and kidney qi deficiency.The incidence of hypertension in spleen and kidney yang deficiency is higher than that in spleen and kidney qi deficiency syndrome.The incidence of hypertension,systolic blood pressure and serum creatinine are higher.24 hours urine protein of spleen and kidney yang deficiency was significantly higher than that of other four deficiency syndrome,while eGFR of spleen and kidney yang deficiency was lower than that of lung and kidney qi deficiency,spleen and kidney qi deficiency and qi yin deficiency(P<0.05).There was significant difference in the score of renal tubulointerstitial lesion among the deficiency syndrome(P<0.05),and the degree of renal tubulointerstitial injury in the syndrome of deficiency of spleen and kidney yang was more serious than that of deficiency of spleen and kidney qi.Multivariate logistic regression analysis was used to analyze the relationship between deficiency of spleen and kidney yang and 24 hours urine protein in patients with hypertension.10.A retrospective analysis of 148 IMN patients treated with hormone therapy or hormone combined with immunosuppressive agents at different time points of TCM deficiency syndrome,hormone treatment before treatment with spleen and kidney yang deficiency,spleen and kidney Qi deficiency,hormone treatment 3 months,spleen and kidney yang deficiency,Spleen and kidney qi deficiency syndrome decreased obviously,while qi and yin deficiency syndrome was the most;hormone treatment for 6 months,qi and yin deficiency,liver and kidney yin deficiency syndrome was more prominent;hormone treatment for12 months qi and yin deficiency,liver and kidney yin deficiency syndrome was more prominent.Conclusion1.Idiopathic membranous nephropathy is more common in middle and old age,male more than female.Nephrotic syndrome is the main clinical manifestation,with hematuria,hypertension,hyperuricemia and renal insufficiency.2.The clinical manifestation and pathological injury is more serious in male,old age patient.3.EGFR was low and tubulointerstitial injury was severe in IMN patients with hyperuricemia.4.Old age and 24-hour urinary protein quantification are the risk factors of hypertension in IMN patients.5.Age,serum uric acid,glomerular global sclerosis and severe tubulointerstitial injury are the risk factors of renal function decline in patients with IMN.Albumin as a protective factor for renal function.6.Most of all IMN patients were due to deficiency of spleen and kidney yang,in which spleen and kidney qi deficiency was the most common in young group,and spleen and kidney yang deficiency was the most common in middle and old age group.The patients with deficiency of spleen and kidney yang were older,their clinical manifestations were heavy,the degree of renal tubulointerstitial injury was large,and the deficiency of spleen and kidney yang was related to 24 hours urine protein quantification of hypertension.7.Before hormone treatment,deficiency of spleen and kidney yang,deficiency of spleen and kidney Qi was the main factor;3 months after hormone treatment,qi and yin deficiency were the most;at 6 months,qi and yin deficiency and liver and kidney yin deficiency syndrome were more prominent;hormone treatment for 12 months qi and yin deficiency,liver and kidney yin deficiency syndrome was more prominent.