Analysis Of Risk Factors For Relapse Of Idiopathic Membranous Nephropathy

ObjectiveThis study aims to study the basic clinical characteristics of patients diagnosed with idiopathic membranous nephropathy who have relapsed after treatment.At the same time,remission patients are divided into relapse groups and the non-relapse group,the differences in clinical data between the two groups of patients were compared,and risk factors were summarized to provide valuable information for clinical decision-making and allow more patients to benefit from treatment.MethodsThis study used a retrospective analysis to analyze the recurrence of 215 patients with idiopathic membranous nephropathy diagnosed by renal biopsy during 2012-2018 year in our hospital.The relapse rate and recurrence rate of relapsed patients were analyzed.Relapse age,relapse time,recurrence inducer,and other factors,compare the general information at the time of biopsy,clinical data at the time of biopsy,general information at the time of remission,clinical data at the time of remission,clinical data at the time of remission,and drug use during treatment.Univariate analysis,COX multi-factor stepwise regression analysis,survival analysis and other methods were used to summarize the risk factors related to relapse.Results1.215 remission patients were included in Guangdong Provincial Hospital of Traditional Chinese Medicine,of which 68 were relapsed patients and 147 were non-relapsed patients.The total recurrence rate was 31.6%.The recurrence ratio of males and females was 6:5.The recurrence rate of males was 34.2%.The recurrence rate of females was 1.28.8%,most of the relapsed patients recurred only once during the follow-up period,accounting for 83.82%,14.71%of the patients relapsed twice,and 1 patient relapsed 3 times,and nearly half of the patients relapsed without obvious incentives.The main causes of recurrence accounted for 25%,followed by exogenous feelings and drug withdrawal.The days of relapses was the highest after 22-24 months,followed by 16-18 months after remission.2.Foaming urine was the most common complaint in relapsed patients than in non-relapsed groups.Among patients with edema as the main complaint,there were more non-re lapsed groups than relapsed groups.The recurrence rate of patients with complete remission was significantly higher than that of patients with partial remission.The urinary protein quantification was higher in the non-relapsed group than in the relapsed group.The patients with infection during follow-up were significantly higher than those in the non-relapsed group.The rate of recurrence of intravenous cyclophosphamide was significantly lower in the group using steroids than in the group not receiving cyclophosphamide,and the rate of relapse was significantly higher in the group using tacrolimus than in the group without tacrolimus.After remission,the recurrence rate of those who did not continue to use Chinese medicine was significantly higher than that of the group that continued to use Chinese medicine.3.Survival analysis of relapse are used in the complete and partial remission groups.The complete relapse rate was 45.2%and the partial relapse rate was 27.1%.The risk of relapse was significantly increased in patients with complete remission,especially after 6 months.The downward trend is even more pronounced.Survival analysis of the hormonal and non-hormonal groups showed a significant increase in the recurrence rate of hormonal patients.The survival analysis of different immunosuppressant types showed that the highest recurrence rate of cyclosporine A is the highest,the recurrence rate of tacrolimus is relatively high,and the recurrence rate of cyclophosphamide is relatively low.4.COX univariate analysis and multivariate stepwise regression analysis showed that:partial remission,cyclophosphamide for immunosuppressive types,continued use of Chinese medicine after remission are independent protective factors for relapse,and use of hormones are independent risk factors for relapse.ConclusionThe recurrence rate of idiopathic membranous nephropathy in our hospital is 31.6%,which is mainly concentrated in 51-70 years old.Most patients have a relapse once.The recurrence causes are mainly fatigue,infection,and drug withdrawal.The main relapse time was within half a year after remission and 1.5-2 years after remission.Complete remission,cyclophosphamide not selected for immunosuppressive type,Chinese medicine not continued after remission.