The Analysis Of Clinical And Pathology Features In Membranous Nephropathy

Objective: To investigate the clinical and pathological features of membranous nephropathy and help clinical diagnosis?appropriate therapy,as well as evaluate prognosis of MN;and at the same time to enhance awareness of atypical membranous nephropathy(AMN)by analyzing 65 cases of membranous nephropathy patients.Methods:Clinical and pathological data were collected from 65 patients who were diagnosed as membranous nephropathy by renal biopsy in Ningxia Hui Autonomous Region people's Hospital from November 2011 to August 2016.Including general situation ?laboratory examination(blood routine,routine urine,24 hour urine protein,urine red blood cell morphology,liver and kidney function,blood lipids,immune index,hepatitis indicators Renal ultrasound)? Pathological data(pathological stage,mesangial proliferation,glomerular sclerosis,crescents formation,tubular atrophy,renal interstitial fibrosis,renal artery thickening,immunofluorescence sedimentary area,types and strength).Patients were divided into different groups according to the different age,24-hour proteinuria,eGFR,hematuria,pathological types.The comparison between different groups of patients were analyzed in both clinical data and pathological characteristics.Meanwhile,the expression of M-type phospholipase A2 receptor(PLA2R)in renal tissue was detected by immunohistochemistry.Results: 1.General status and clinical date analysis :The mean age of 65 patients was50.5±14.5 years old,more common in the medium-elderly man,with a ratio of male to female1.71:1.45 cases(84.9%)performed as nephritic syndrome(NS),54 cases with hematuria(83.1%),1 case of them gross hematuria;19 cases(29.2%)associated with hypertension,60cases(92.3%)showed hyperlipidemia,and 25 cases(38.5%)were in renal function decline.2.Clinical and pathological data analysis:(1)The idiopathic membranous nephropathy(IMN)was predominantly in male patients(68.3% vs 37.5%),atypical membranous nephropathy(AMN)was more common in female patients(50% vs 19.5%)(P <0.05).(2)Different age group:Male patients are common in all age.There was a higher prevalence of hypertension and a lower prevalence of eGFR in elderly group than young group(P<0.01).(3)Different degree of proteinuria group: The patients with a large amount of proteinuria showesd a lower level of serum albumin,eGFR and a higher level of cholesterol and serum creatinine(P < 0.05).(4)Different eGFR group: The serum creatinine level is higher in older age patients in the eGFR<90 ml/min group(vs the eGFR >90 ml/min group,P<0.01).(5)Different degree of hematuria group: The young patients suffered hematuria more(vs group without hematuria,P<0.05).3.IMN were accounted for 37 cases(56.9%),including phase I 22 cases(59.5%),phase II 11 cases(29.7%),I-II 4 cases(10.8%).There were no the phase III and IV in IMN.The AMN were 20 cases(30.8%),and SMN were 8 cases(12.3%),inside,hepatitis B related membranous nephropathy is the most common,accounted for 6 cases(75.0%),and 2 case of Type V lupus nephritis(V-LN)(25.0%).Immunofluorescence staining was given priority to with IgG,(100%).Compared with AMN,the proportion of male in IMN is higher(75.7% vs.40%,P < 0.05).AMN and SMN have higher rate of mesangial proliferation,IgA,C1 q deposition rate(vs IMN,P < 0.01).The incidence of IMN in male patients was higher than that in AMN(P <0.05).Patients with secondary membranous nephropathy The serum albumin level were lower in SMN patients than that in IMN patients(P <0.05).4.Expression of PLA2 R in renal tissue: the positive rates of PLA2 R in IMN,AMN and SMN were 90.6%,93.3% and 42.9% respectively.The results showed that the expression of PLA2 R were higher in IMN and AMN patient than that in th SMN patients(P = 0.014).Conclusion: Membranous nephropathy often occurs in middle and old aged male patients.The age and a large number of proteinuria are the risk factors for MN renal function progression.The incidence of AMN is significantly increased.The positive PLA2 R expression in AMN is as same as in IMN.