Clinical Features And Prognosis Of Patients With Idiopathic Membranous Nepfropathy With Tubulointerstital Injury

Purpose:To investigate the clinical characteristics,renal pathological characteristics and curative effects of different treatment schemes in patients with idiopathic membranous nephropathy(IMN)with and without tubulointerstitial injury.To investigate whether renal tubulointerstitial injury is a risk factor affecting the prognosis of patients with IMN.Subjects:300 patients with IMN confirmed by renal biopsy,secondary membranous nephropathy(SMN)and IMN without hormone and immunosuppressive therapy were excluded by clinical and pathological examination.Methods:According to the Ehrenreich-Chrug membrane nephropathy staging criteria,a semi-quantitative integral score is given according to the proportion(%)of tubular atrophy and renal interstitial fibrosis area.In this study,the score of≥2 was defined as tubular interstitial injury,and 300 patients diagnosed with IMN were divided into the group without tubular interstitial injury(group A,246 cases)and the group with tubular interstitial injury(group B,54 cases),and clinical data and pathological data were collected for clinical retrospective analysis.These patients were followed up for 6 months to 24 months after treatment with hormones combined with cyclophosphamide(CTX)and hormone plus Calmodulinase inhibitors(CNIs)to compare the overall response rate and complete response rate between the two groups.Cox univariate and multivariate analysis was used to analyze clinical,pathological variables and factors affecting renal prognosis with different treatment regimens.Results:Group B was older,more male,with 24-hour urinary protein(24-HUPRO),Serum creatinine concentration(SCr),cystatin C(Cystatin C,CysC),urea nitrogen(BUN),β 2-microglobulin(β 2-microglobulin,The levels of β 2-MG)and anti-phospholipase A2 antibody(anti-PLA2R antibody)were higher than those in group A,and the differences were statistically significant(P<0.05).The two groups were mostly in stages Ⅰ and Ⅱ,and the pathological manifestations of group B were more severe;In terms of glomerulosclerosis,mesangial hyperplasia,inflammatory cell infiltration,vascular lesions,acute tubular injury,balloon adhesions,focal segmental segmental glomerulosclerosis(FSGS),etc.,they were all higher than in group A,and the differences were statistically significant(all P<0.05).After 1 year of follow-up after treatment,the overall response rate(CR+PR)in group B was lower(66.67%VS 80.89%),and the difference was statistically significant(P<0.05).After using the hormone combined CSA/TAC treatment regimen,the complete response rate(CR)in group B was significantly lower than that in group A(13.79%VS 35.56%),and the difference was statistically significant(P<0.05)。Analysis of all clinical and pathological variables using Cox univariate analysis found that 24-HUPRO,antipla2R antibody,beta2-MG,chronic tubular interstitial lesions,and FSGS were all risk factors for worsening renal condition.For some statistically significant risk factors,multivariate COX regression analysis revealed that antipla2R antibodies are independent risk factors for deterioration of renal function(p=0.021).Conclusions:IMN patients with tubulointerstitial injury have more severe clinical manifestations,more severe pathological injury,and lower overall remission rate,especially the complete remission rate.IMN patients with tubulointerstitial injury should use CNIs with caution.Univariate analysis 24-hupro,anti pla2r antibody β2-mg,chronic renal tubular disease and FSGS are the risk factors affecting the deterioration of renal condition.Multivariate analysis showed that anti pla2r antibody was an independent risk factor for the deterioration of renal function.