Effect Of Anti - Erythropoietin Antibody On Severe Anemia In Maintenance Dialysis Patients

Objective: To detect the exist of anti-erythropoietin antibody and its concentration in the serum of chronic renal failure patients with severe anemia,at the same time, bone marrow biopsy examination is performed. To explore the role of antierythropoietin antibody in patients with chronic renal failure severe anemia(including erythropoietin induced pure red blood cell aplastic anemia) in the pathogenesis of anemia,provide the treatment basis for the correction of severe renal anemia and improve the diagnosis and curative effect.Methodology: 40 patients with chronic renal failure who have accepted the application of recombinant human erythropoietin injection for more than 4 months,but hemoglobin levels fall suddenly or keep falling,reticulocyte counts decreases significantly, the white blood cell and platelet level is normal, or sustained resistance to recombinant human erythropoietin or without reaction, haemoglobin levels below the normal level, when dosage is the same or increases. Meanwhile detect the exist of anti-erythropoietin antibody and perform bone marrow biopsy examination(identify the diagnosis of pure red blood cell aplastic anemia). Anti-erythropoietin antibody is detected by western blot and enzyme-linked immunosorbent(ELISA),two methods to determine the exist of anti-erythropoietin antibody, and measure the concentration.Results: In the serum of 40 patients with chronic renal failure patients, 15 cases of the patients had detectable anti-alpha-erythropoietin antibody(37.5%),among them 1 case had detectable anti-beta erythropoietin antibody(2.5%); 6 cases were identifiable as pure red blood cell aplastic anemia by bone marrow biopsy examination in 13 patients who had bone marrow examination. The anti-EPO-antibody concentration of anti-EPO-Ab positive group was significantly higher than the negative group. Partial analysis showed that the antibody concentration was negative to RET and SI.Conclusions: Anti- erythropoietin antibody can be detected by western bolt method,ELISA method, Anti- erythropoietin antibody are closely associated with chronic renal failure patients with severe anemia, and plays an important role in the pathogenesis.Objective:To analysis the clinical and pathological features among idiopathic membranous nephropathy(IMN), hepatis B virus related membranous nephropathy(HBV-MN) and Type V lupus nephritis(V-LN) in adults.Methods:221 cases of patients with renal biopsy identified membranous nephropathy in our hospital were collected from January 2006 to December 2011. The clinical and pathological features were compared between three types of membranous nephropathy.Results:The IMN, V-LN, HBV-MN, accounted for 66.52%, 22.17%, 11.31% of three types of membranous nephropathy respectively. Nephrotic syndrome, edema were common in three types of membranous nephropathy. The level of serum C3, C4 had a significant reduction in V-LN associated with extrarenal manifestations. At the time of renal biopsy, the most patients are classified as stage Ⅱor Ⅲlesions, and there were excessive deposits of Ig G and C3 in kidney tissue. The deposits of C3、C1q were more than that in IMN and HBV-MN, veriety of immune complex deposit is also common in three types of membranous nephropathy.Conclusion:There are some differences in clinical manifestations and renal pathology in renal membranous lesion, which is helpful to differential diagnosis.