| Objective: The aim of this study was to explore the correlation between serum uric acid(UA)levels and the clinical,pathological and prognostic aspects of adult idiopathic membranous nephropathy(IMN).Methods: Retrospective analysis of clinical,pathological,laboratory and outpatient follow-up data of 112 patients who were confirmed by renal biopsy pathology as IMN patients in the Department of Nephrology of our hospital from April 2010 to April2022.The clinical data include the patient’s sex,age,blood pressure,etc;the laboratory data include the patient’s peripheral blood uric acid(SUA),creatinine(Scr),albumin(Alb),urea nitrogen(Bun),C-reactive protein(CRP),glomerular filtration rate(e GFR),etc;The pathology is divided into stages I,II,III and IV according to the Ehienierch-Churg criteria.The severity of tubulointerstitial lesions,including:(1)interstitial inflammatory cell infiltration;(2)interstitial fibrosis;and(3)tubular atrophy,was also assessed;the endpoint of follow-up was defined as an estimated decrease in e GFR to half of that at the time of IMN diagnosis or the patient’s progression to end-stage renal disease.These patients were divided into Group I(SUA>420umol/L)(37 patients),Group II(335umol/L<SUA<420umol/L)(38patients)and Group III(SUA<335umol/L)(37 patients)according to the tertile of their serum uric acid levels at diagnosis.Results:(1)Among the 112 IMN patients,69 males and 43 females with an average age of 49.25±14.02 years,the mean follow-up time was 21.14±6.81 months,with a total of 27 people(24.1%)reaching the follow-up endpoint.the number of patients with hyperuricemia(HUA)was 43,accounting for 38.39%;(2)Of the three groups,group I had older patients,shorter time to follow-up endpoints,higher 24 h proteinuria quantification,higher blood urea nitrogen(BUN)and low-density lipoprotein(LDL-C)values,with statistically significant differences(p < 0.05);the differences in gender,serum albumin,triglycerides and cholesterol were not statistically significant;(3)Of the three groups of IMN patients,48(42.86%)were stage I patients,57(50.89%)were stage II patients,a total of 7(6.25%)were stage III patients,and no stage IV patients were collected,with no statistically significant pathological stage,but there were significant differences in renal tubular atrophic lesions among the three groups of IMN patients(P < 0.05),and the remaining indicators: including sphericity sclerosis,segmental sclerosis,thylakoid hyperplasia,and lymphomonocyte infiltration were not significantly different;(4)logistic analysis showed that 24 h protein quantification,LDL-C,and BUN were correlated to the occurrence of hyperuricemia in IMN patients(P < 0.05);(5)the effect of uric acid on renal outcomes showed that,Without controlling for other dependent variables,patients in group II were 5.073[1.378,18.683] times more likely to have an adverse outcome than patients in group III,and patients in group I with blood uric acid levels were 22.501 [5.281,95.873]times more likely to have an adverse outcome event than patients in group III;after correcting for variables such as age,BUN,tubular atrophy and interstitial fibrosis,LDL-C,and 24-hour urine protein quantification,patients in group II were 4.354[1.138,16.655] times more likely to have a poor outcome than patients in group III,and patients in group I were 20.394 [4.379,94.979] times more likely to have an adverse outcome event than patients in group III;while in subgroup analyses for gender,after controlling for dependent variables and after correcting for multifactorial variables,groups I and II had no significant differences from Group III showed no gender differences in prognosis.(6)Kaplan-Meier survival analysis showed a rapid decrease in renal survival in groups I and II(p < 0.05).Conclusions: Serum uric acid level is a relevant risk factor affecting clinical symptom relief and prognosis of renal function in IMN patients.Furthermore,no gender differences existed when serum uric acid was used as a predictor of IMN prognosis. |
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