| Objective:To study the changes of the number of podocyte and expression of nephrin in renal tissue of idiopathic membranous nephropathy（IMN）patients,and to explore the clinical correlation between serum anti-PLA2R antibody and podocyte damage.Methods:Forty-five inpatients with PLA2R-related IMN diagnosed by kidney biopsy in nephrology department of Shengjing Hospital Affiliated to China Medical University from June 2019 to February 2020 were enrolled as IMN group,and their kidney tissue when first kidney biopsy was collected.Seven renal tissue specimens in patients with ureteral urothelial carcinoma were gathered as tissue control group.Fifty-three healthy volunteers from medical examination center were included as the control group.The expression of WT1 and nephrin in renal tissue was detected by immunohistochemistry.Podocyte number and density were estimated by WT1-positive cells in special formula.The clinical information,the levels of serum anti-PLA2R antibody,related clinical indexes and follow-up data of IMN group were collected.Podocyte number,density and nephrin average optical density（AOD）in control group and IMN group were compared.The changes of podocyte density and nephrin AOD of IMN patients in different levels of anti-PLA2R antibody or proteinuria were comparatively analyzed.The correlation between podocyte density,nephrin and anti-PLA2R antibody was explored.Results:1.Compared with control group,IMN group showed higher Cys C,TG,TC,LDL-C,and lower e GFR and Alb（P<0.05）.2.WT1 was expressed in the nucleus and cytoplasm of glomerular podocyte.The number of WT1-positive cells in IMN group was significantly less than those in tissue control group,and the staining of WT1 was lighter.The number and density of podocyte in the IMN group were lower than those in the control group（P<0.05）.Nephrin was both expressed along glomerular capillary loops.Different from tissue control group,nephrin in IMN group was distributed unevenly,diffusely,and always non-linearly.The nephrin AOD in IMN group was significantly lower than that in tissue control group（P<0.05）.3.The levels of TC,HDL-C,LDL-C,24h-UP,and Urea in anti-PLA2R antibody positive group were significantly higher than the negative group（P<0.05）,and the levels of nephrin AOD,Alb were significantly lower than the negative group（P<0.05）;no statistical significance was found in podocyte density between above groups（P>0.05）.4.Compared with low proteinuria group,high proteinuria group had higher levels of anti-PLA2R antibody,Urea,Scr,and 24h-UP（P<0.05）;meanwhile,lower nephrin AOD,podocyte density,Alb,and complete remission ratio（P<0.05）.5.Nephrin AOD and podocyte density were negatively correlated with anti-PLA2R antibodies（P<0.05）in Spearman correlation analysis.But in multiple linear regression analysis,nephrin AOD was negatively correlated with 24-UP or incomplete remission（P<0.05）;and podocyte density was negatively correlated with incomplete remission ratio（P<0.05）.There is no linear correlation between nephrin AOD,podocyte density and anti-PLA2R antibody（P>0.05）.Conclusion:Podocyte injury remains in kidney tissue of IMN patients.There is no correlation between podocyte number or expression of nephrin and anti-PLA2R antibody,the levels of serum anti-PLA2R antibody is not completely consistent with IMN renal podocyte injury.The less losses of nephrin or podocyte,the milder podocyte injury and the better prognosis of IMN. |
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