| Objective:This paper retrospectively analyzed the clinical、 pathological manifestations andlaboratory test results of patients of pathological diagnosis for idiopathic membranousnephropathy、Hepatitis B virus associated membranous nephropathy and lupus nephritis withtype Ⅴ,and summed up the general pathogenetic conditions、 clinical、 pathologicalcharacteristics the relationship between the clinical and pathological,aiming at improving thecorrect diagnosis、 identification、 treatment and prognosis of the three membranousnephropathy,and also offering some new clues for the pathogenesis research.Method:The number of patients in this analysis is219, who were diagnosed idiopathicmembranous nephropathy(168cases)、Hepatitis B virus associated membranous nephropathy(30cases) and lupus nephritis with type Ⅴ(21cases) by renal biopsy at the Department ofNephrology in the Second Hospital of Jilin University during January1,2002to March15,2012.All of the219cases have complete clinical data,and we derived the data fromhospital,including gender、age、living environment、clinical performance、pathologicalmanifestations and laboratory test results and so on. We use an application of statisticalsoftware~SPSS to establish a database and analyzed all above data.Results:1、Gneral performance：The ratio of the three membranous nephropathy which areidiopathic membranous nephropathy（168cases）、Hepatitis B virus associated membranousnephropathy（30cases） and lupus nephritis with type Ⅴ（21cases） is8:1.43:1.Inidiopathic membranous nephropathy patients，the mean age i（s48.2±14.6）years(the range:14to84years old); there are114male cases and54female cases, occurring more common inmale with the ratio of male to female2.11:1; the ratio of urban to rural was1.4:1; Highincidence aged41-60years old.In Hepatitis B virus associated membranous nephropathypatients, the mean age is（41.9±16.1）years(the range:13to79years old); there are26malecases and6female cases, occurring more common in male with the ratio of male to female6.5:1; the ratio of urban to rural was1.1:1; High incidence aged21-40years old. In lupus nephritis with type Ⅴ patients, the mean age is（37.4±13.8）years(the range:15to61yearsold); there are2male cases and19female cases, occurring more common in female with theratio of male to female1:9.5; the ratio of urban to rural was1.6:1; High incidence aged40-60years old.2、In the Idiopathic membranous nephropathy cases,the numbers of men and womenunder40years oid are almost equal, and over the age of40there are more male patients thanfemale; In Hepatitis B virus-associated membranous nephropathy patients, of most ages aredominated by men; In lupus nephritis with typeⅤ,of all ages women occupy the vastmajority.3、 Clinical manifestations: The most common clinical manifestations of threemembranous nephropathy are nephrotic syndrome, followed by hematuria, hypertension andrenal dysfunction, no significant differences in above clinical manifestations incidence. Inthe comparison of laboratory test results, the serum C3and C4levels in idiopathicmembranous nephropathy patients is significantly higher than in lupus nephritis with typeⅤ patients (p <0.05).4、The relationship between age, gender and proteinuria, hypertension: the incidence ofproteinuria (>3.5g/24h) in male slightly higher than the female, but there was not statisticalsignificance (P>0.05), in the IMN the incidence of proteinuria in each age group patientswere the same.76cases with IMN patients followed by hypertension,64cases were male,12cases were female, accounting for56.1%and22.2%of the IMN male and female patients;12cases with HBV-MN patients followed by hypertension,11cases were male,1cases werefemale, accounting for42.3%and25%of the HBV-MN male and female patients,all themale patients with LN-V followed were hypertension,female were12cases,accounting for52%of the LN-V female patients; the incidence of hypertension inpatients of all ages was no significant difference (P>0.05).5、Pathological manifestations: In idiopathic membranous nephropathy, II stage was themost common type, followed by Ⅰ, Ⅲ and Ⅳ stage; In Hepatitis B virus associatedmembranous nephropathy,both Ⅱ、Ⅲ stage are common,followed by Ⅰ、Ⅳ stage;In lupusnephritis with type Ⅴ,patients are mainly inⅠpathological stages,followed by II, III, IVstage. Comparing with idiopathic membranous nephropathy,the mesangial cell proliferationand tubuto-interstitial lesions in pathological of Hepatitis B virus-associated membranous nephropathy and lupus nephritis with type Ⅴ were more significantly (p>0.05).Immunofluorescence:The incidence of multi-site deposition in the HBV-associatedmembranous nephropathy is significantly higher than the IMN (p <0.05); The incidence of"Full bright" phenomenon and multi-site deposition in Lupus nephritis with type Ⅴ wasalso significantly higher than the IMN (p <0.05). Deposition of IgG and C3are mainlycommon found in all of three membranous nephropathy, especially the deposition of C1q inthe hepatitis B virus-associated membranous nephropathy and lupus nephritis with type Ⅴwere both significantly more common found than in the IMN (p <0.05); In addition,deposition of IgA in lupus nephritis with type Ⅴ was significantly more common foundthan in the IMN (p <0.05).6、The relationship between pathological changes and renal function, gender, age,proteinuria, hypertension: the incidence of tubulointerstitial lesions in renal failure patientswere significantly higher than in normal renal function patients (p <0.05). The incidence oftubulointerstitial lesions of male patients in three membranous nephropathy was significantlyhigher than female (p <0.05). The incidence of tubulointerstitial lesions in the above50-year-old patients was significantly higher in patients below50-years-old (p <0.05). Theincidence of tubulointerstitial lesions in above8g/24h patients was significantly higher inpatients below8g/24h group (p <0.05). The incidence of tubulointerstitial lesions in patientsfollowed by hypertension was significantly higher than not followed by hypertension(p<0.05).Conclusion:1、The ratio of idiopathic membranous nephropathy、Hepatitis B virus associatedmembranous nephropathy and lupus nephritis with type Ⅴ is8:1.43:1.In idiopathicmembranous nephropathy patients，the mean age is（48.2±14.6）years;the ratio of male tofemale is2.11:1with occurring more common in male; high incidence aged41-60yearsold.In Hepatitis B virus associated membranous nephropathy patients, the mean age is（41.9±16.1）years;the ratio of male to female is6.5:1with occurring more common in male;high incidence aged21-40years old. In lupus nephritis with type Ⅴ patients, the mean ageis（37.4±13.8）years; the ratio of male to female is1:9.5with occurring more common infemale; high incidence aged40-60years old.2、IMN patients with onset age and sex has its own unique, secondary membranous nephropathy, age, gender distribution, depending on the specific cause is different.3、The most common clinical manifestations of three membranous nephropathy arenephrotic syndrome, followed by hematuria, hypertension and renal dysfunction. In thecomparison of laboratory test results, the serum C3and C4levels of lupus nephritis withtype Ⅴ patients decreased significantly, and this can be used as an important basis foridentification with IMN.4、There is relationship between the incidence of hypertension and gender in the threemembranous nephropathy.5、In the idiopathic membranous nephropathy, the most common pathological stage isstage II; In the hepatitis B virus-assoeiated membranous nephropathy both stage II and III isthe most common; In the lupus nephritis type Ⅴ, stage Ⅰis the most common. Moderate/severe mesangial proliferation, the deposition of C1q in the hepatitis B virus associatedmembranous nephropathy and lupus nephritis with type Ⅴ, multi-site deposition of immunesubstances and the "Full bright" phenomenon can be used as the most important differentialpoints of three membranous nephropathy6、There is a certain relationship between the tubule-interstitial lesions and the renalfailure, gender,age,hypertention, proteinuria. We can’t determine the degree of pathologicaldamage in the three membranous nephropathy by the severity of the clinicalmanifestations,and renal biopsy is an indispensable means to determine lesion severity. |
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