| Objective:To analyze the clinical data and follow-up of patients with autoimmune disease related membranous nephropathy,and to investigate the incidence of autoimmune disease-associated membranous nephropathy and analyze the clinical features,pathological features,and therapeutic effects of membranous nephropathy associated with systemic lupus erythematosus and primary Sjogren’s syndrome in order to improve the understanding and research of membranous nephropathy associated with autoimmune diseases.And provide evidence for clinical diagnosis and treatment.Methods:A total of 1061 cases of membranous nephropathy diagnosed by renal biopsy in the second hospital of Jilin University from January 2010 to December 2017 were collected,including 89 cases of autoimmune disease related membranous nephropathy.The distribution and clinical data of 89 patients were retrospectively analyzed.The clinical and pathological characteristics of lupus nephritis Ⅴ and primary Sjogren’s syndrome related membranous nephropathy were analyzed,and the therapeutic effects of 27 patients were followed up.Enrollment criteria: clinically confirmed patients with systemic lupus erythematosus,primary Sjogren’s syndrome,rheumatoid arthritis,mixed connective tissue disease,ANCA-associated vasculitis,IgG4-related disease,and renal biopsy pathological diagnosis of membranous lesions;according to the results of renal pathology with or without renal interstitial injury Lupus nephritis Ⅴ and primary Sjogren’s syndrome related membranous nephropathy patients were divided into simple glomerular injury group and glomerular injury with renal interstitial injury group.Exclusion criteria: Exclude membranous nephropathy caused by drugs,infections,tumors,hepatitis virus,syphilis,and heavy metals,and exclude lupus nephritis Ⅲ+Ⅴ and Ⅳ+Ⅴ.Statistical analysis using SPSS24.0 statistical software for analysis.Results:1.Distribution of diseases: From January 2010 to December 2017,1061 cases of membranous nephropathy were diagnosed by renal biopsy in our hospital,among which there were 89 cases of autoimmune disease related membranous nephropathy(8.4%).Including 58 cases(65%)of systemic lupus erythematosus,20 cases(23%)of primary Sjogren’s syndrome,4 cases of mixed connective tissue disease(5%),3 cases of rheumatoid arthritis(3%),ANCA Related vasculitis in 3 cases(3%),IgG4-related disease in 1 case(1%).2.General clinical data: Among the 89 patients,there were 13 males and 76 females,with a male to female ratio of 1:5.8.Among LN-MN patients,6 were males and 52 were females.The male to female ratio was 1:8.7.In pSS-MN patients,there were 4 male and 16 female,and the male and female ratio was 1:4.The average age of renal biopsy was 43.1 + 14.1 years,and the peak age of the disease was 40-60 years(42 cases,47.2%).At the time interval of diagnosis of membranous lesions and primary diseases,in less than 1 years,1-5 years and more than 5 years,there were 7 cases,10 cases and 9 cases respectively.3.General laboratory examination: The positive rate of triglyceride in LN-Ⅴ group was higher than that in pSS-MN group(P<0.01),and the reduction of red blood cells and hemoglobin was easy to occur in LN-Ⅴ group compared with pSS-MN group(P<0.05).4.Immunology related examination: The positive rate of anti-dsNDA antibody,anti-U1 RNP antibody,ARPA,SM antibody,and P-ANCA in LN-Ⅴ group was higher than that in pSS-MN group(P<0.01).The incidence of the decrease of complement C3 and complement C4 in LN-Ⅴ group was higher than that of pSS-MN group.RF positive rate in pSS-MN group was higher than LN-Ⅴ group(P<0.05).5.Renal pathology: There was no significant difference in light microscopy between the LN-Ⅴ group and the pSS-MN group.The positive rate of IgA,C4,and C1 q deposition in the LN-Ⅴ group was higher than that in the pSS-MN group(P<0.05).6.Comparison between simple glomerular injury group and glomerular injury with renal interstitial injury group: LN-Ⅴ patients with renal interstitial injury group were prone to urinary RBC-positive,anemia,and elevated Scr(P <0.05).pSS-MN patients had no statistically significant difference between the two subgroups.7.Treatment and follow-up: In 27 follow-up cases,22 cases were LN-Ⅴ,5 cases were pSS-MN,and hormone combined with cyclophosphamide was the most commonly used treatment(14 cases,51.9%),followed by tacrolimus(5 cases,18.5%).The total remission rates of 3 months,6 months,and 1 years were 77.8%,92.6% and 89.5%,respectively.Conclusion:1.The single-center study of autoimmune diseases with membranous lesions accounting for membranous nephropathy was 8.4%,with SLE being the most common and pSS second;the proportion of men with pSS related membranous nephropathy may be higher.2.Patients with LN-Ⅴ were more likely to have anemia and elevated triglycerides than patients with pSS-MN.The results of immunological tests in both groups were similar to those of primary SLE and pSS.3.There was no difference in pathological changes of renal pathology between LN-Ⅴ and pSS-MN groups.Immunofluorescence examination showed that IgA,C4,and C1 q deposition were more likely to occur in LN-Ⅴ patients,which was consistent with other pathological types of LN.4.In patients with LN-Ⅴ,renal interstitial lesions are more likely to have hematuria,anemia,and serum creatinine than patients with glomerular injury;in pSS-MN patients,there is no difference between the two groups.5.The remission rates of 27 patients with LN-Ⅴ and pSS-MN at follow-up of 3 months,6 months were 77.8% and 92.6%,respectively. |
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