A Case Report Of Idiopathic Membranous Nephropathy And Review Of The Literature

Objective: The aim is to discuss the epidemiological trends,pathogenesis,diagnosis and antidiastole methods,treatments and prognostic factors of the idiopathic membranous nephropathy(IMN)through analyzing typical case of IMN,which to improve the understanding,diagnosis and treatment level of IMN.Method: This report retrospectively analyzed the clinical data of one typical patient with IMN,integrated with literature report at home and abroad,discuss the epidemiological trends,pathogenesis,diagnosis and antidiastole methods,treatments and prognostic factors of the IMN.Results: The patient,female,47 year-old,reported both lower limbs edema for over 2 years with much proteinuria(highest to 10.3 g/d),hypoproteinemia(lowest to 21.9g/L),hypertension.Renal biopsy pathological results: phase Ⅱ membranous nephropathy.Clinical diagnosis: nephritic syndrome,phase Ⅱ membranous nephropathy.Treatment: glucocorticoid combining cytoxan(CTX),and symptomatic supportive treatment,CTX was stopping given up to 8g and glucocorticoid was reduced regularly to zero,and patient achieved clinical remission.We give Cyclosporin A after relapse,continuous declination in urine protein,the disease condition is almost alleviated.Conclution: Idiopathic membranous nephropathy is one of the common pathological types of nephritic syndrome in adults,and its morbidity has increased year by year recently.The disease used to appear mostly in middle aged and elderly people,with a male female ratio of 2:1.The onset mechanism of IMN remains unclear,and current studies consider podocyte autoantigen PLA2 R is an important pathogenic target antigen.The diagnosis of IMN depends on renal pathological examination,which needs to exclude secondary membranous nephropathy in the first place.As for IMN treatment,domestic and overseas experts all suggest to select therapeutic plan based on the levels of proteinuria and serum albumin and the changes in disease condition,or applying immunosuppressive therapy when necessary.The first choice for immunosuppressive therapy in clinical practice is glucocorticoid combining cytotoxic drugs,and the new therapy targeting on onset mechanism is still under clinical experiments.The natural disease course of IMN is relatively long,and about 1/3 patients has spontaneous remission.The confirmed primary unfavorable prognosis factors are urine protein and duration,renal function condition of onset or deterioration during disease course,hypertension,and severe tubulointerstitium pathological alterations.The latest research indicates the tittering of PLA2 R antibody and its changes had superior predictive value to IMN prognosis.