| Objective:Membranous nephropathy(membranous nephropathy,MN)is one of the most common pathological types of nephrotic syndrome in adults,according to the causes can be divided into idiopathic membranous nephropathy(idiopathic membranous nephropathy,IMN)and secondary membranous nephropathy.According to statistics at home and abroad,the incidence of IMN has shown an increasing trend in recent years.The cause of IMN is not known,but the latest research shows that the occurrence of IMN may be related to environmental factors.Environmental pollutants arsenic,cadmium,lead,manganese and chromium have been confirmed to be heavy metals with nephrotoxicity.However,there is no study on the relationship between environmental heavy metals arsenic,cadmium,lead,manganese and chromium exposure and IMN.The purpose of this study was to investigate the distribution of heavy metal concentrations in the urine of IMN and the control group,and to study the effect of environmental heavy metal exposure on the pathogenesis of idiopathic membranous nephropathy,so as to provide a scientific basis for elucidation of the possible risk factors of IMN and the corresponding prevention and treatment measures.Methods:In this study,124 adult patients with idiopathic membranous nephropathy(IMN)who were admitted to the department of nephrology of a third-grade grade a hospital in Guangxi from September 2016 to December 2018were selected as the case group,124 healthy volunteers were selected as the control group in the same hospital and occupational physical examination population.Urine samples of patients were collected in the morning after admission,and the contents of arsenic,cadmium,lead,manganese,chromium and other heavy metals in urine were detected by ICP-MS.SPSS21.0 software was used to conduct descriptive statistical analysis of the basic conditions of IMN and control group,and the median grouping of heavy metal elements in urine was adopted,and univariate and multivariate Logistic regression analysis was used to explore the relationship between the distribution of heavy metal concentration in urine of case control group and the occurrence risk of IMN.Results:1.The educational level of IMN group was lower than that of the control group,and the difference was statistically significant(p<0.01).The number of patients with BMI<18.5kg/m~2 and 18.5-23.9kg/m~2 in the case group was less than that in the control group,and the number of patients with BMI24kg/m~2 was more than that in the control group.The difference in BMI between the two groups was significant(p<0.01).The number of smokers and passive smokers in the case group was higher than that in the control group,and the difference was statistically significant(p<0.05).2.Logistic multivariate analysis showed that the risk of IMN in BMI 24kg/m~2group was 2.56 times higher than that in 18.5-23.9kg/m~2 group(95%CI:1.47-4.49,p<0.01)after adjusting for confounders.Smoking status was different,and the risk of IMN was 1.88 times higher for smokers than non-smokers(95%CI:1.08-3.25,p<0.05).The risk of IMN was 0.39 times(95%CI:0.20-1.75,p<0.05).3.Urinary chromium,manganese and cadmium concentrations in the IMN group were higher than those in the control group after creatinine comparison,and the difference was statistically significant(p<0.01).4.The heavy metal concentrations were grouped according to the median of the control group,and the low-concentration group was used as the control group for univariate logistic regression analysis.The results showed that chromium,manganese and cadmium were correlated with the incidence of IMN(p<0.01).After further adjusting for confounding factors such as gender and age,the Logistic regression analysis results showed that the risk of IMN in the high concentration group of chromium,manganese and cadmium was 6.37 times(95%CI:3.20-12.73,p<0.01),3.77 times(95%CI:2.00-7.09,p<0.01)and 4.84times(95%CI:2.52-9.31,p<0.01)than that in the low concentration group.Conclusion:1.Obesity or overweight and smoking are risk factors for IMN.Therefore,controlling body weight and smoking can prevent the occurrence of membranous nephropathy to a certain extent.2.Heavy metals such as chromium,manganese and cadmium are significantly associated with the occurrence of IMN and may be environmental risk factors for the occurrence of IMN.Therefore,reducing the exposure of environmental heavy metals such as chromium,manganese and cadmium has certain public health significance for preventing the occurrence of IMN. |
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