Clinicopathological Characteristics And Prognosis Idiopathic Membranous Nephropathy Of Single Center

Objective:To explore the clinicopathological characteristics and prognosis of 327patients with idiopathic membranous nephropathy.Methods:Patients diagnosed with membranous nephropathy by renal biopsy at the Department of Nephrology,The First Affiliated Hospital of Dalian Medical University from December 1,2014 to December 31,2019 were included.Clinical and pathological data and outcome were collected.Patients were divided into spontaneous remission group and non-spontaneous remission group.The patients without spontaneous remission group were divided into drug-induced remission group and no remission group.The primary endpoint was complete and partial remission of proteinuria,and the follow-up endings was the end stage renal disease（ESRD）or e GFR reduction by more than 30%from the baseline.Statistical analysis was performed using the SPSS software,version 26.0.Logistic regression was applied to compare the correlation between induced remission and clinical and pathological indicators;Kaplan-Meier survival curves were applied to analyze renal outcomes;Cox regression was applied to analyze independent risk factors for spontaneous remission,independent risk factors for complete remission of proteinuria and independent risk factors for progression of renal function in IMN patients.Application of ROC curve to clarify the baseline proteinuria Cutoff value for spontaneous remission.P<0.05 was considered to be statistically significant.Results:1.327 IMN patients were enrolled according to the inclusion and exclusion criteria.Of these,27.5%patients were in spontaneous remission,60.9%patients were drug-induced remission,and 11.6%were no remission,and a relapse rate of 6.4%.2.In comparison with patients who did not develop spontaneous remission group,patients with SR had a higher serum albumin,e GFR,serum uric acid and serum Ig G,and lower proteinuria,mean arterial pressure,the proportion of nephrotic syndrome,24-hour urinary protein and the titer of anti-PLA₂R（P<0.05）;The degree of renal tubular atrophy and renal interstitial fibrosis was mild in the spontaneous remission group（P<0.05）.Multivariate analysis identified that mean arterial pressure（HR 0.963,95%CI[0.936-0.990],P=0.007）and 24-hour urine protein（HR 0.645,95%CI[0.537-0.775],P<0.001）were independent prognostic factor of complete remission of proteinuria.Further ROC curves were performed to clarify the Cutoff value of 3.95 g/24h for spontaneous remission of baseline proteinuria in IMN patients（AUC=0.845,P<0.001）.3.Compared with the no remission group,patients in the drug-induced group had higher e GFR and serum Ig M levels and lower serum creatinine and the ratio of glucocorticosteroid and tacrolimus/cyclosporine therapy（p<0.05）.Multivariate Logistic regression analysis showed that drug-induced remission was significantly associated with e GFR（OR=1.051,95%CI[1.019-1.083],P=0.001）.4.Kaplan-Meier analysis showed that poorer renal survival in patients in the no remission group（P<0.001）,compared to the drug-induced group.5.Univariate Cox regression analysis showed that age,nephrotic syndrome,serum albumin,blood creatinine,urea nitrogen,serum cholesterol,serum triglycerides,proteinuria,glomerulosclerosis,tubular atrophy and interstitial fibrosis were prognostic factors of complete remission of proteinuria.Multivariate analysis identified that proteinuria（HR 0.918,95%CI[0.869-0.969],P=0.002）was independent prognostic factor of complete remission of proteinuria.6.Univariate Cox regression analysis showed that hypertension（HR 3.226,95%CI[1.603-6.492],P=0.001）and glomeruli sclerotic（HR 19.980,95%CI[4.865-82.048],P<0.001）were risk factors of renal function deterioration.Multivariate analysis identified that hypertension（HR 2.686,95%CI[1.290-5.596],P=0.008）and glomeruli sclerotic（HR 9.553,95%CI[2.082-43.842],P=0.004）were independent risk factors of renal function deterioration.Conclusion:1.This IMN study cohort had a spontaneous remission rate of 27.5%,an induced remission rate of 60.9%,a non-remission rate of 11.6%,and a relapse rate of 6.4%.2.Mean arterial pressure and baseline proteinuria are independent risk factors for spontaneous remission of proteinuria in IMN patients.3.Baseline proteinuria is an independent risk factor for complete remission of proteinuria in IMN patients;hypertension and glomerulosclerosis are independent risk factors for progression of renal function.