Pathology And Long-term Prognosis Of65Cases Of Children’s Membranous Nephropathy

Objective: To analyze the clinical and pathological data of children’smembranous nephropathy, in order to guide the clinical diagnosis andtreatment.Method:65children with MN were collected in our hospital fromDec.2003to Dec.2012.The clinical features, pathology, reaction oftreatment and long-term prognosis were retrospectively summarized baseon the data.Results:①65patients in total, accounting for4.9%of all renal biopsypatients.30patients with IMN(46%),19patients with HBV-MN(29%),and16patients with LN(25%).②There is no significant gender difference inIMN patients. But the radio of male:female of LN is1:4.33,andHBV-MN is5.33:1.③Nephrotic syndrome is common type in both IMNand secondary membranous nephropathy, most of the patients accompanymicroscopic hematuria.④The increase of IgG,the decrease of serumC3,C4and the abnormality of autoantibodies have significant difference in LN(P<0.05).⑤Subepithelial immune complex deposits and diffusethickening of glomerular basement membrance are the typical pathologicalcharacteristics of MN, most of them have IgG,C3deposit, but the moderateof mesangium cell proliferation, renal interstitial damage, varied immunecomplex deposit are obvious in secondary membranous nephropathy（P<0.05）.Besides, HBV antigen deposit in kidney tissues is the mostimportant characteristic in HBV-MN.⑥23patients were given oral steroidsalone initially, immunosuppressants were given to non-responders or reliersto steroids, the clinical remission rate of combined treatment is obviouslyhigher than using steroids alone（P<0.05）.⑦The age of onset over10yearsold shows worse prognosis than those under10years old（P<0.05）.Conclusion: Secondary membranous nephropathy is more commonthan IMN in children’s MN. Nephrotic syndrome is common type in bothof them. Renal biopsy is an important tool to diagnosis and differentialdiagnosis.Most of the patients are non-responders or reliers to steroids,some of them may get bad prognosis. The age of onset, nephrotic-rangeproteinuria, hypertension, renal insufficiency are the main prognosticfactors. Early diagnosis, early intervention and regular treatment isnecessary to improve the prognosis of the patients.