Clinicopathological Features Of Idiopathic Membranous Nephropathy And Analysis Of Influencing Factors Of Treatment

ObjectiveThis study summarized the TCM syndrome and clinicopathological features of idiopathic membranous nephropathy,analyzed the risk factors of serum creatinine elevation at biopsy in patients with idiopathic membranous nephropathy,and analyzed the treatment effect of combination of traditional Chinese and Western Medicine on idiopathic membranous nephrosis and its influencing factors,so as to provide guidance for clinical treatment of idiopathic membranous nephropathy.MethodsIn this study,a retrospective analysis of medical records was used to analyze the correlation of TCM syndrome,clinical indicators and pathological features of idiopathic membranous nephropathy.The two classified logistic regression was used to investigate the risk factors of serum creatinine elevation at biopsy.Analyzing the efficacy of integrated traditional Chinese and Western medicine in the treatment of idiopathic membranous nephropathy,and to explore the factors influencing the therapeutic effect by Cox regression analysis.Results1.429 patients with idiopathic membranous nephropathy were included in the study,and most of them were over 40 years of age,the male to female ratio was about 1.19:1,42.9% patients are combined with hypertension,51.1% patients was nephrotic syndrome,48.4% patients have renal function decline at biopsy.The main pathological stage was stage II(65.7%),atypical membranous nephropathy was not uncommon(12.4%),80.9% patients had tubulointerstitial lesions.2.Younger patients had a higher proportion of atypical membranous nephropathy,and older patients had more severe pathological injuries.Urine protein was higher in patients being characterized by male,hypertension,nephrotic syndrome,renal function decline,glomerular segmental sclerosis,and tubulointerstitial injury.Renal function was wores in patients being characterized by male,Advanced age,long course of disease,hypertension,hyperproteinuria,glomerular sclerosis,glomerular segmental sclerosis,crescent formation,renal tubulointerstitial injury.3.The idiopathic membranous nephropathy was marked by the deficiency of the spleen and kidney qi deficiency most(83%),followed by Qi and yin deficiency,spleen and kidney yang deficiency and other syndromes,and the main demonstration was water wet,damp heat,wet turbid and blood stasis,with water damp stasis syndrome,damp heat stasis syndrome(41%,33.3% respectively),and simple blood stasis syndrome(4.4%).There was no significant difference in clinical and pathological features in different asthenia syndrome.4.Serum creatinine increased in about 19.3% patients at biopsy.Logistic regression analysis showed that age more than 50 years old,hypertension,segmental glomerular sclerosis,renal tubule atrophy were independent risk factors for serum creatinine elevation in patients with idiopathic membranous nephropathy(OR values were 3.425,2.282,2.923,4.931,respectively).5.The overall remission rate of integrated traditional Chinese and Western medicine for idiopathic membranous nephropathy was 75.8%,and the median remission time was 8 months.The most commonly used inhibitors were glucocorticoids combined with cyclophosphamide,followed by glucocorticoids combined with tacrolimus/cyclosporine.In Chinese medicine group,the remission rate was 65.8%,the median remission time was 12 months,the Chinese medicine combined with glucocorticoids/immunosuppressive group was 80.4%,and the median remission time was 9 months.The age of biopsy was less than or equal to 50 years old and combined glucocorticoids/immunosuppressive agents were the favorable factors for the relief of idiopathic membranous nephropathy(HR = 1.371 and 1.402 respectively).Conclusion1.Idiopathic membranous nephropathy is common in the middle-aged and the elderly,mostly with swelling of the limbs,the clinical manifestation of nephrotic syndrome,the deficiency of spleen and kidney qi was the main dialectic of traditional Chinese medicine,and the main reason was water damp stasis resistance,damp heat stasis.The pathological stage was mainly stage II,and the proportion of young patients with atypical membranous nephropathy was relatively high.Age over 50 years old,hypertension,glomerular sclerosis,and tubular atrophy are independent risk factors for elevated serum creatinine in idiopathic membranous nephropathy.2.The overall remission rate of the combination of Chinese and Western medicine in the treatment of idiopathic membranous nephropathy was 75.8%,the remission rate of Chinese medicine group was 65.8%,Chinese medicine combined with glucocorticoids/immunosuppressive group was 80.4%.The most commonly used immunosuppressant scheme was glucocorticoids combined with cyclophosphamide,followed by glucocorticoids combined with tacrolimus/cyclosporin.The age of biopsy was less than 50 years old,combined glucocorticoids/immunosuppressant were the favorable factors for the relief of idiopathic membranous nephropathy.