| Background and ObjectiveMembrane nephropathy is one of the main causes of nephrotic syndrome in adults.The onset of the disease is often relatively insipid.In recent years,it has shown a trend of younger age.Through retrospective analysis of the treatment of patients in our center,the prognosis of patients with idiopathic membranous nephropathy treated by immunotherapy and non-immunotherapy are not clear.The purpose of this study was to explore the prognosis and related factors of patients with idiopathic membranous nephropathy treated with immunotherapy and non-immunotherapy.To provide clinical basis for the timing of immunotherapy for patients with membranous nephropathy in the future.MethodsA total of 94 patients with idiopathic membranous nephropathy were selected from Qilu Hospital of Shandong University from January 2018 to March 2020,who underwent percutaneous renal puncture pathology in the hospital for the first time,and were followed up for 12 months.Patients who had a complete or partial response during follow-up were included in the spontaneous response group and patients receiving immunotherapy were included in the immunotherapy group.The basic data,blood and urine biochemical indexes,renal pathology and other results of patients were collected to evaluate the influence of non-immunotherapy related factors in patients with idiopathic membranous nephropathy.According to the results of urine protein and so on,patients in the immunotherapy group with partial or complete response were included in the response group,and patients without response were included in the non-response group.The basic data of patients,blood and urine biochemical indexes,renal pathology and other results were collected to evaluate the effect of immunotherapy and the influence of related factors.Results1.A total of 94 patients with idiopathic membranous nephropathy(mean age 44.59±13.20 years)were included in this study,including 61 males(64.9%)and 33 females(35.1%).Among them,there were 20 patients(21.3%)in spontaneous remission group,16 patients(80.0%)in males and 4 patients(20.0%)in females,with an average age of 42.85±15.28 years.There were 74 patients(78.7%)in the immunotherapy group,including 45 males(60.8%)and 29 females(39.2%),with a mean age of 45.05±12.66 years.2.Comparison of clinical data between patients in the spontaneous response group and those in the immunotherapy group showed higher serum albumin and immunoglobulin G levels in the spontaneous response group.High density lipoprotein(HDL),low density lipoprotein(LDL),anti-PLA2R antibody,urinary immunoglobulin G,and urinary microalbumin levels were higher in the immunotherapy group than in the spontaneous response group.The pathological changes of renal basement membrane and infiltration of inflammatory cells in renal interstitium were more serious in the immunotherapy group than in the spontaneous remission group.3.Multivariate regression analysis indicated that the level of anti-PLA2R antibody<19.4RU/mL,high-density lipoprotein and the thickening degree of basement membrane in renal tissue were the independent influencing factors of spontaneous response.4.The levels of eGFR and serum albumin in the immunotherapy remission group were higher than those in the non-remission group.The levels of creatinine and uric acid in the remission group were lower than those in the non-remission group.Multivariate regression analysis indicated that serum creatinine level was an independent factor affecting the prognosis of the immunotherapy group.Conclusions1.The levels of serum albumin and immunoglobulin G were higher in the spontaneous response group.The levels of high density lipoprotein,anti-PLA2R antibody,urine immunoglobulin G and urine microalbumin were low.2.The level of anti-PLA2R antibody<19.4RU/mL,high density lipoprotein and the thickening degree of basement membrane in renal tissue were independent influencing factors for spontaneous remission of idiopathic membranous nephropathy.3.The levels of eGFR,serum albumin and creatinine and uric acid in the remission group were higher than those in the immunotherapy group.Serum creatinine level at renal needle biopsy was an independent predictor of prognosis in the immunotherapy group. |
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