Clinicopathological Characteristics And Prognosis Of Patients With Idiopathic Membranous Nephropathy Complicated With Hypertension

Objective:To investigate the clinicopathological features and prognostic risk factors in patients with idiopathic membranous nephropathy(IMN)companied with hypertension.Methods:208 patients with membranous nephropathy(MN)diagnosed by renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Fujian Medical University from September 2015 to August 2019 were collected.187 patients with IMN were selected according to the inclusion and exclusion criteria.According to the diagnostic criteria of hypertension,they were divided into hypertension group and non-hypertension group.The clinical and pathological features of the two groups were retrospectively analyzed and compared.The above baseline data were statistically described and analyzed by two independent sample t-test,rank sum test and chi-square test.The renal survival rates of the two groups were compared with nonparametric product limit estimation(Kaplan-Meier method)at the end point of serum creatinine doubling or entering end-stage renal disease(ESRD)or renal replacement therapy,and the risk factors affecting the progression of IMN were analyzed by stepwise Cox regression model.Results:1.Among the 187 patients with IMN included in this study,the incidence of hypertension was 42.78%.The age of onset,the proportion of RAS blockers and immunosuppressive drugs used in the hypertension group were higher than those in the non-hypertensive group,and the baseline eGFR in the hypertension group was lower.(all P<0.05).The gender,serum creatinine,concomitant hematuria,24-hour urine protein quantitation,serum total cholesterol,serum triglyceride,blood anti-PLA2R positive rate,blood uric acid,prothrombin time,D-dimer,international standardized ratios,and glucocorticoid usage rate were not significantly different between the two groups(all P>0.05).2.The pathological stages of the hypertension group were mainly stage Ⅰ and stage Ⅱ,with 46 cases(57.5%)and 29(36.25%),respectively.There was no significant difference in pathological stage distribution between the two groups(P>0.05).The renal tubular injury score(TIL)and renal chronicity index(CI)in the hypertensive group were higher than those in the non-hypertensive group(both P<0.05).Compared with the non-hypertensive group,the hypertensive group had more the incidence of tubule atrophy,interstitial inflammatory cell infiltration,and renal small vessel disease increased,P<0.05,with statistical difference.There was no significant difference between the two groups in mesangial hyperplasia,interstitial fibrosis,crescent formation,kidney IgG4 positive rate,and kidney PLA2R positive rate(all P>0.05).3.Based on binary logistic regression analysis,age and renal vascular disease are independent risk factors for hypertension in IMN patients(P<0.05).4.Kaplan-Meier survival curve showed that the cumulative survival rate of kidneys in hypertension group was significantly lower than that in non-hypertension group(Log-rank test:χ~2=6.844,P=0.009).Univariate COX regression analysis showed that hypertension,serum creatinine,baseline eGFR,blood albumin,prothrombin time,pathological stage,chronicity index(CI),and crescent formation were risk factors affecting the prognosis of IMN patients(P<0.05).Multivariate COX regression analysis showed that baseline eGFR(HR=1.102,P=0.029)and crescent formation(HR=28.01,P=0.012)were independent risk factors that affected renal prognosis in IMN patients.Conclusions:IMN patients with hypertension are older than non-hypertensive patients,with a lower baseline eGFR and more severe renal pathological damage.The renal survival rate of patients with IMN and hypertension is lower.Hypertension can be used as a marker of poor renal prognosis in IMN patients.Crescent formation and baseline eGFR are independent risk factors that affect renal prognosis in IMN patients.