Prognostic Factors Of Idiopathic Membranous Nephropathy

Background:Idiopathic membranous nephropathy(IMN)remains to be the most common cause of nephrotic syndrome(NS)in China,resulting in a variety of clinical outcomes in different people.The majority of patients can achieve remission after treatment while some patients have poor response to all therapies and will finally progress to end stage renal disease.Using baseline clinical parameters to predict the prognosis of the disease and guide therapeutic schemes is meaningful.To our knowledge,there were few relevant researches based on Chinese population.Object:To analyze the association between baseline clinical parameters and the prognosis of idiopathic membranous nephropathy(IMN).Method:This retrospective study included patients who were diagnosed with idiopathic membranous nephropathy(IMN)by renal biopsy during 2010.1.1 to 2015.12.31 in Kidney Disease Center of The First Affiliated Hospital of Zhejiang University,with a follow-up time more than 6 months.We analyzed the association between baseline clinical parameters and the remission of IMN.Multivariate Logistic regression was used to select independent risk factors for remission.The long-term outcomes and complications were also compared.Result:A total of 534 patients were included in our study.The number of patients in complete remission,partial remission and non-remission group was 258,191 and 85 respectively.Single factor analysis showed that initial clinical parameters including age,body mass index(BMI),serum creatinine,glomerular filtration rate,urea nitrogen,urinary protein,urinary protein/creatinine,uric acid,urine NAG enzyme,urinary immunoglobulin IgG,urinary albumin,urinary retinol binding protein(RBP),urine beta2-microglobulin,total cholesterol,albumin and diabetes were associated with the remission of IMN.Multivariate Logistic regression revealed that old age,high BMI,high urinary protein/creatinine,low serum albumin and diabetes were independent risk factors for remission in patients with IMN.The recurrence rate in complete remission group was significantly lower than that in partial remission group(19.8%vs 41.4%,P<0.001).Long-term renal function was stable in patients who achieved remission(complete remission or partial remission).In the non-remission group,there were 19 patients whose serum creatinine doubled and 6 of them progressed to end stage renal disease.The incidence of moderate-severe anemia during follow-up period in non-remission group was significantly higher than that in remission group(P<0.05).Conclusion:Old age,high BMI,high urinary protein/creatinine,low serum albumin and diabetes mellitus were independent risk factors for remission in patients with IMN.The recurrence rate of complete remission group was significantly lower than that of partial remission group.Patients with persistent non-remission proteinuria had a poor prognosis.