Clinical And Pathology Analysis Between Atypical Membranous Nephropathy And Idiopathic Membranous Nephropathy

Objective：We analysised the clinicopathological of atypical membranousnephropathy, and compared it with idiopathic membranousnephropathy, in order to provide the basis for reasonable clinicaldiagnosis and treatment and judge the prognosis.Methods:We retrospectived and analysised the integrated clinical andpathological datas of192cases of patients with membranous nephropathy(including AMN76cases, IMN116cases), which has been confirmed byrenal biopsy in ou hospital between January2013and October2014, andanalyzed them by using the application of statistical software SPSS22.0.Results:1. There was976cases of renal biopsy in our hospital during thesame period, the pathology type of MN was228cases, accounted for22.37%. And the AMN was91cases, accounted for39.91%, the IMN was137cases, accounted for60.09%.2. The ratio of male to female in AMN patients was about1.38:1,and in IMN the ratio was about2.43:1, the majority of both were male,but there was no statistical difference (p>0.05) in the incidence of maleand female.3. The average age was39.74±17.74years old in the76cases ofAMN patients, and in116cases of IMN the average age was49.62±12.06 years old, and AMN was younger than IMN, and there was statisticaldifferences (p<0.05) in the average age of the two groups, the peak agewas31to40years old in AMN and41to50years old in IMN.4. In76cases of AMN, the clinical manifestations of nephriticsyndrome was57cases (70.7%), acute renal failure was4cases (5.3%)and chronic renal failure was2cases (2.6%);31cases of themaccompanied with hypertension (40.8%) and65cases (85.6%) withmicroscopic haematuria. In116cases of IMN, the clinical manifestationsof nephrotic syndrome was82cases (72.4%), acute renal failure was5cases (4.3%), chronic renal failure was3cases (2.6%) and50cases(43.1%) associated with hypertension,84cases (72.4%) with microscopichaematuria.There was no statistical incidence in nephritic syndrome、acute or chronic renal failure and hypertension of the two groups，butexisted statistically difference(p<0.05) in microscopic haematuria, and theAMN was higher than the IMN.5. There was no statistical difference in the average of blood ureanitrogen and creatinine between AMN and IMN, the average of uric acid,retinol, inhibition C, blood immunoglobulin IgG, IgA, IgM, complementC3, C4and thyroid function T3，T4were both in nomal level in AMN andIMN; the levels of triglyceride, cholesterol,24h urine protein quantitativeand trace albumin, α1microglobulin, β2microglobulin, IgG, TSH werehigher than normal on average, and the blood albumin was lower thannormal. There was no statistical difference (p>0.05) in the above index,but the urine protein quantitative, TSH were higher in AMN than IMN onaverage, the blood albumin was lower in IMN, and the CRP levels washigher than normal in AMN group and in the normal range in IMN.6. During the Light microscopy in76cases of AMN,there was35cases (46.1%) glomerular sclerosis,34cases (44.7%) spikes formed,14 cases (68.4%) inflammatory cells infiltration,44cases (57.9%) renaltubular-interstitial atrophy,52cases(68.4%) inflammatory cells infiltration,47cases (61.8%) fibrosis,34cases (44.7%) abnormal renal vasculararteriole;116cases of AMN,57cases（49.1%）glomerular sclerosis,26cases (22.4%) spikes formed,26cases22.4%) inflammatory cellsinfiltration,71cases (61.2%) renal tubular-interstitial atrophy,75cases(64.7%) inflammatory cells infiltration,72cases (62.1%) fibrosis,46cases (39.7%) abnormal renal vascular arteriole.The spikes formation ratewas statistically difference (p <0.05) in the two group. The depositionrate of immunoglobulin IgG, IgA, IgM were respectively75cases(98.7%),42cases (52.6%),52cases (68.4%) and the complement C3,C4,C1q, FRA were respectively from68cases (89.5%),56cases (73.2%),53cases (69.7%),34cases (44.7%) in76cases of AMN; and thedeposition rate of immunoglobulin IgG, IgA, IgM were respectively114case（s98.3%）、39case（s33.6%）、54case（s46.6%）and the complementC3, C4, C1q, FRA were92cases（79.3%）、56cases（48.3%）、53cases（45.7%）、40cases（34.5%）in116cases of IMN; The positive depositionrate of immune globulin IgA, IgM and complement C4, C1q, FRA hadstatistically significant (p <0.05) in the two groups, AMN was higherthan IMN. Both AMN and IMN had irregular thickening of glomerularbasement membrane and epithelial cell foot process fusion under theelectron microscope.And AMN has mesangial cells and matrixhyperplasia and electron dense depositioned in many parts, but IMNwithout the above changes.There were no special renal tubule andinterstitial lesions In the two groups.Conclusions:1. The AMN accounted for the proportion of MN was as high as39.91%, the main manifestations was nephrotic syndrome, the majority of which was young men, and the average age was younger than IMN,microscopic haematuria and spikes formation rates were higher than theIMN, the above of which indicated AMN may be an independent MN.2. There was no statistically difference of laboratory examinationindexes in AMN and IMN,we can’t identify AMN and IMNaccordingly the laboratory examination indexes.3. The AMN and IMN were both characterized by thickening ofglomerular basement membrane, the spikes formation and the positivedeposition rates of immunoglobulin IgA, IgM and complement C4, C1qwere higher in AMN than in IMN. There was mesangial cell andmesangial matrix hyperplasia, and electron dense presents many partsdeposition under electron microscope.