Analysis Of The Correlation Between Urinary Protein And Treatment Or Prognosis Of Stage Ⅱ Idiopathic Membranous Nephropathy

Objectives:To investigate the correlation between urinary protein and treatment or prognosis in stage Ⅱ idiopathic membranous nephropathy.The effects of different levels of urine protein on the therapeutic effect and prognosis were analyzed to provide the way to even safer and more effective individually tailored therapeutic options,and to postpone the progress of the disease.Methods:Patients were recruited from the department of Nephrology at the Yan’ an Hospital Affiliated to Kunming Medical University from January 2012 to May 2017,and a total of 94 IMN-II patients were enrolled in this study.Diagnosis was confirmed by renal biopsy.Patients with infections,cancer,systemic lupus erythematosus,and/or drug-induced secondary membranous nephropathy were excluded from the study.The clinicopathological data and follow-up of the biopsy were analyzed retrospectively.Results:(1)The incidence of BMN ranks second in the PGN,only behind IgA nephropathy.The proportion of IMN-Ⅱ in IMN is as high as 81.87%,and it occurs in the elderly over 50 years old(73.40%).(2)Among 94 IMN-Ⅱ patients,there were 43 males(45.74%)and 51 females(54.26%).The average age was 54.48±13.21 years old(including 2 patients<18 years old).The main clinical manifestations were nephrotic syndrome in 81 patients(86.17%),with microscopic hematuria in 60 cases(63.83%),41 cases with hypertension(43.62%),13 cases(13.83%)in CKD stage 3～5.(3)According to the 24-hour total urinary protein(24h-UP),patients were divided into 3 groups,15 cases(15.96%)of low-risk group,44 cases of moderate-risk group(46.81%),35 cases of high-risk group(37.23%).The high-risk group was dominated by male patients(65.71%),the other two groups had more female patients(63.34～73.33%),patients in the moderate-and high-risk group with hematuria(65.71～75%)were significantly higher than those in the low-risk group(26.67%),and there were significant differences among the three groups in BMI,TCH,LDL-C and ALB(P<0.05).(4)Treatment with steroids combined with immunosuppressive agents was followed up for 4 to 69 months(The median follow-up time was 12 months),the total effective rate of high-risk group was 94.29%(partial remission(PR)54.29%+complete remission(CR)40%),while moderate-risk group was 88.64%(PR 38.64%+CR 50.00%)and low-risk group was 93.33%(PR 26.67%+CR 66.67%),with no statistical difference.However,in the aspect of CR,the high-risk group was lower than moderate-risk group,while moderate-risk group was lower than the low-risk group.In terms of treatment sensitivity,there was no statistical difference of the median time to reach the target of PR and CR or 24h-UP decreased by 50%,75%,90%in the three groups,but there were 9(25.71%)patients in the high-risk group relapsed,while 7(15.91%)in the moderate-risk group,no recurrence was found in the low-risk group.There was a significant difference among the three groups(P=0.03).(5)Prognosis:In terms of stable renal function,without eGFR deterioration and mild decline(eGFR<30%)were 80.00%in the low-risk group,86.36%in the moderate-risk group,85.71%in the high-risk group;while renal function deterioration(eGFR)≥30%)in the low-risk group reached 20.00%,in the moderate-risk group 13.64%,and in the high-risk group 14.29%.Only one patient in the low-risk group(6.67%)and the high-risk group(2.86%)progressed to ESRD,and one patient in the moderate-risk group(2.27%)had non-renal death.The overall prognosis of the three groups of patients were good,and there was no statistical difference in the prognosis.(6)There is no significant correlation between 24h-UP and treatment or prognosis of the disease IMN-Ⅱ.Conclusion(s):(1)The incidence of IMN ranks second in the PGN,only behind IgA nephropathy.The proportion of IMN-Ⅱ in IMN is as high as 81.87%,and it occurs in the elderly over 50 years old,The clinical manifestations were mainly nephrotic syndrome(86.17%).(2)A total of 94 cases of IMN-Ⅱ were grouped and analyzed,The high-risk group was dominated by male patients,while more female patients in the moderate-and low-risk group.The level of proteinuria in male was higher than that in female patients,suggesting that men may be an adverse factor in the progression of IMN-Ⅱ.(3)After follow-up with steroids combined with immunosuppressive agents for IMN-Ⅱ,the overall efficiency of the patients in the high-,moderate-and low-risk group were similar and the treatment sensitivity were not statistically significant,but the recurrence rate of high-and moderate-risk group were significantly higher than that of low-risk group,suggesting that the amount of urine protein were not significantly related to the efficacy and sensitivity of the treatment.But the higher the 24h-UP,the more the IMN-II relapsed.At the same time,the rate of complete remission in high-risk group was lower than moderate-risk group while the moderate-risk group was lower than that in low-risk group,and the time of complete remission in the high-risk group was longer than that in the moderate-and low-risk groups.(4)The overall prognosis of IMN-II are good,and the 24h-UP may not be directly related to the prognosis of the disease.It requires a prospective randomized controlled study or a large sample and prolonged follow-up study.