The Clinical Symptoms Of56Cases Of Idiopathic Membranous Nephropathy

Objective: To collate, count, analysis, summarize epidemiology, clinicalmanifestations,laboratory tests, clinical and pathologic relationship of the inpatientwith idiopathic membranous nephropathy diagnosised by biopsy for accumulatingclinical experience.Methods: Retrospectively analyze clinical symptoms of56IMN cases,Includingepidemiology,linical manifestation,laboratory findings and pathological characteristicsetc.According to gender,age (18to44years old for the youth group,≥45years as theolder group), pathologic stage (Iperiod,I～Ⅱ, Ⅱ and more),renal function (eGFR>90ml/min/1.73㎡for normal renal function group,eGFR≤90ml/min/1.7㎡renalfunction decline group) were grouped separately compare the clinicalmanifestations,laboratory examination,the difference pathological data.Results: In56patients with IMN,there are36male cases（64.3%）and20femalecases（35.7%）, occurring more common in male with the ratio of male to female1.8:1,aged18to62years,with an average age of41.61±11.07years. IMN Clinicallymanifested as nephrotic syndrome in49cases （87.5%）,edema in47cases（83.9%）,microscopic hematuria in42cases（75.0%）,hypertension in7cases（12.5%）.In pathological staging,Ⅰ stage accounted for22cases（39.3%）,Ⅰ～Ⅱ13cases（23.2%），Ⅱ21cases（30.4%），Ⅱ～Ⅲ2cases（3.6%），Ⅲ2cases（3.6%）.Lens check the mesangial obvious hyperplasia0cases (0.0%), crescent2cases (3.6%),segmental sclerosis7cases (12.5%), renal tubular atrophy22cases (39.3%),interstitialinflammatory cell infiltration29cases (51.8%),small artery wall thickening of12cases (21.4%).Fluorescence immunoassay test IgA0cases (0.0%), IgM6cases(10.7%),IgG54cases (96.4%),C344cases (78.6%),C47cases (12.5%),C1q11cases(19.6%),F4cases (7.1%) were positivee.Uric acid men on average373.71±66.57μmol/L, women on average286.17±45.28μmol/L,men is higher than women on theaverage uric acid,the difference was significant (P=0.000).In pathologic stageing,Ⅰ10men (27.8%) and12females (60.0%),a higher proportion of women (P=0.018);Ⅱperiod and more than17men (47.2%) and4females (20.0%), a higher proportion of men (P=0.044).Mean duration of the youth group341.74±159.00days,themiddle-aged group was1302.72±706.28days, the difference wassignificant(P=0.006).Light microscopic examination of small artery wall thickeningyouth group3patients (9.7%),8cases (32.0%) in the older group,the difference wassignificant(P=0.037).In terms of comparative microscopic hematuria,Ⅰ period of21cases (95.5%),Ⅰ～Ⅱ stage7cases (53.8%),Ⅱ period and more than14cases(66.7%), the difference was significant(P=0.012).Uric acid Ⅰ of306.63±77.22μmol/L,Ⅰ～Ⅱ of325.76±85.10μmol/L,Ⅱ period and above390.30±63.36μmol/L,thedifference was significant（P=0.002）,and uric acid increases with the increase ofpathological staging.The pathological staging and nephrotic syndrome,edema,microscopic haematuria,hypertension,eGFR,Scr,etc no correlation. Microscopichematuria group with normal renal function37cases（84.1%）,5cases （41.7%） inrenal dysfunction group,the difference was significant(P=0.003).Blood urea nitrogenBUN group with normal renal function of4.18±1.50mmol/L,renal dysfunction groupof6.39±2.28mmol/L,the difference was significant(P=0.001).Serum creatinine groupwith normal renal function of64.53±13.35μmol/L,renal dysfunction group of108.96±26.69μmol/L,the difference was significant (P=0.000). CysC group withnormal renal function of0.96±0.20mg/L,renal dysfunction group of1.26±0.24mg/L,the difference was significant (P=0.000).Uric acid group with normal renalfunction of325.18±76.82μmol/L,renal dysfunction group of405.74±72.23μmol/L,the difference was significant (P=0.002).Renal dysfunction group microscopicexamination revealed a higher proportion of tubular atrophy (P=0.004).Conclusion: The most common clinical manifestations of IMN are nephriticsyndrome,75%with microscopic hematuria that was commonly seen in pathologicalstage Ⅰ and normal renal function of the IMN patients.High uric acid increased visibleat the pathological staging, kidney function decline in men.In IMN,Ⅰ andⅡ periodwas the most common pathological staging. Terminal IMN with renal dysfunction wasoften visible in patients with renal tubular atrophy. No correlation between thepathological staging and clinical manifestations.