Clinical And Pathological Features And Prognosis Of Adults With Idiopathic Membranous Nephropathy With IgM Deposition

Objective To analyze the clinical and pathological features and prognosis of adults with idiopathic membranous nephropathy with IgM deposition.Methods 99 adults with idiopathic membranous nephropathy(IMN),who were first diagnosed by renal biopsy as membranous nephropathy in Fujian Medical University Union Hospital Nephrology Department from March 1st,2015 to October 31st,2018,were retrospectively analyzed.Clinical and pathological features and renal outcomes in IMN patients with IgM deposition and without IgM deposition were compared.The endpoint was that e GFR was decreased 30%than baseline and<60 ml/(min·1.73m~2)at median follow-up of 8.80 months.Renal survival was assessed via Kaplan-Meier survival curves and to identify whether IgM deposition is an independent prognostic factor by univariate analysis and multivariate Cox regression analysis.Results 1.Clinical characteristics:(1)Clinical characteristics of 99 IMN patients:6 cases were admitted in 2015,16cases were admitted in 2016,34 cases were admitted in 2017,43 cases were admitted in2018;57 were male(57.58%),42 were female(42.42%),and we find that the ratio between males and females was 1.36:1;26 were young(26.26%),47 were middle-aged(47.47%),26 were senile(26.26%),average age was(50.48±13.10)years old,and average course was 3.00(1.00,6.00)months;there were 71 patients with nephrotic syndrome(71.72%),28 patients with nephritic syndrome(28.28%),41 patients with hypertension(41.41%),77 patients with large amounts of proteinuria(77.78%),77patients with hematuria(84.85%),75 patients with hypercholesterolemia(75.76%),58patients with hypertriglyceridemia(58.59%),and 34 patients with hyperuricemia(including 24 males and 10 females)(34.34%).(2)Comparison to clinical characteristics of the patients between two groups:there were no differences in gender,age,course of disease,incidence of NS and hypertension,SBP,DBP,MAP,large amount of proteinuria,Hb,blood BUN,e GFR,female’s blood uric acid,TG,TC,serum Ig G,Ig A,C3 and C4(all P>0.05).However,24 hours urinary protein quantitation,SCr,serum IgM and male’s blood uric acid in group with IgM deposition were higher than those in group without IgM deposition(all P<0.05).2.Pathological characteristics:(1)Pathological characteristics of 99 IMN patients:4 patients’pathological stage was stage I(4.04%),80 patients’pathological stage was stage II(80.81%),14 patients’pathological stage was stage III(14.14%),and 1 patient’s pathological stage was stage IV(1.01%).There were 61 patients with glomerular sclerosis(61.62%),16 patients with segmental sclerosis(16.16%),51 patients with glomerulosclerosis(51.51%);there were 57 patients with tubular atrophy(57.58%),16 patients with severe tubular atrophy(16.16%),24 patients with interstitial fibrosis(24.24%),17 patients with severe interstitial fibrosis(17.17%),84 patients with thickened vascular wall(84.85%),18patients with hyaline degeneration(18.18%);there were 99 patients with Ig G deposition(100%),87 patients with C3 deposition(87.88%),66 patients with IgM deposition(66.67%),14 patients with C1q deposition(14.14%),and 7 patients(7.07%)with Ig A deposition.(2)Comparison to pathological characteristics of the patients between two groups:there were no differences in pathological stage,glomerular sclerosis,segmental sclerosis,tubular atrophy,thickened vascular wall,hyaline degeneration,Ig G deposition,Ig A deposition,C1q deposition and C3 deposition(all P>0.05).However,the proportion of patients with severe tubular atrophy,interstitial fibrosis and severe interstitial fibrosis in group with IgM deposition were higher than those without IgM deposition(all P<0.05).3.Prognostic characteristics:(1)85 IMN patients’follow-up data:at median follow-up time of 8.80 months,8patients reached endpoint events(9.41%).69 patients received immunosuppressive therapy(81.18%),77 patients received ACEI/ARB treatment(90.59%),and there were39 patients with infections(45.88%),4 patients with acute kidney injury(4.71%),and 3patients with thromboembolism(3.53%).(2)Comparison of the follow-up data between two groups’patients:there were no significantly differences in the proportion of patients receiving immunosuppressive therapy,receiving ACEI/ARB therapy,with infections,with acute kidney injury and with thromboembolism(all P>0.05).2 patients without IgM deposition(6.90%)and 6patients with IgM deposition(10.71%)reached endpoint events,but there was no difference(P>0.05).Kaplan-Meier analysis showed that there was no difference in renal survival between two groups(Log-rank testχ~2=0.001,P=0.971).Univariate and multivariate Cox regression analysis identified that IgM deposition was not an independent risk factor for the progression of renal dysfunction in adult IMN patients(P>0.05).Conclusions(1)Adult IMN patients in our hospital are more common in males with middle-aged.Nephrotic syndrome can be seen in mostly patients.Stage II is the most common pathological stage,and all of patients are accompanied by Ig G deposition.(2)The baseline of creatinine in adult IMN patients with IgM deposition is higher than that without IgM deposition,and the degree of proteinuria is more severe.(3)As for pathological damage,the renal tubular and interstitial change of adult IMN patients with IgM deposition are more severe.(4)IgM deposition is not an independent risk factor for renal function progression in adult patients with IMN.