| BackgroundMembranous nephropathy(MN)is a group of diseases characterized by deposition of glomerular basement membrane(GBM)epithelial cells and immune complexes with diffuse thickening of GBM,divided into idiopathic membranous nephropathy(IMN)and secondary membranous nephropathy.The etiology of the former is not yet clear,the pathogenesis is more complicated,and the prognosis shows a large individual difference.Current studies have shown that the natural course of IMN has three forms of outcome,namely spontaneous remission,persistent proteinuria with stable renal function and persistent proteinuria with decreased renal function.Clinical follow-up data showed that about one-third of patients had spontaneous remission of proteinuria,one-third of patients had persistent proteinuria and stable renal function,while the remaining patients had persistent proteinuria and decreased renal function.Renal interstitial fibrosis(RIF)refers to excessive deposition of extracellular matrix(ECM)components in the renal interstitium and proliferation of renal interstitial fibroblasts due to multiple causes.The degree of RIF is closely related to the degree of renal impairment.Studies have shown that renal interstitial lesions are the most important influencing factors for the 10-year renal survival rate of membranous nephropathy.The idiopathic membranous nephropathy(IMN)mostly belongs to the category of "urine turbidity" and "edema" in Chinese medicine according to its clinical manifestations.Western medicine often uses hormones and immunosuppressants for treatment,and long-term use has obvious toxic and side effects.With the wide application of Chinese medicine in the treatment of IMN,Chinese medicine has certain advantages in treating this disease.However,the pathological features associated with RIF idiopathic membranous nephropathy and TCM syndromes are few.ObjectiveTo investigate the syndromes,clinical and pathological features of idiopathic membranous nephropathy with renal interstitial fibrosis.MethodsUsing a single-center,retrospective study method,patients who were diagnosed as having been diagnosed with IMN from the Department of Nephrology at***Hospital between January 2006 and December 2016 were observed and studied.According to the renal biopsy pathology reports of whether renal interstitial fibrosis is involved,300 patients will be divided into the RIF group(215 cases)and the non-RIF group(85 cases).Compare TCM symptoms,syndrome differentiation,clinical manifestations,and renal pathological data between the two groups,and preliminary explore the correlation between IMN renal interstitial fibrosis and TCM syndromes and clinical pathology.Results1.TCM symptoms distributionCompare two groups of major TCM symptoms,the symptoms with an incidence greater than 10%are sorted by edema>weary>foam urine>Backache>Dry mouth>Nocturia>Mouth bitter>Abdominal fullness,the proportion of edema in the RIF group was significantly higher than that in the RIF group(80.9%vs69.4%),that is statistically different(P=0.031P<0.05);The other symptoms was found no statistical difference(P>0.05)?2.The type of TCM syndrome(1)The overall distribution of TCM syndromes,300cases of IMN patients were enrolled into this restrospective study,and 4 cases were only with deficiency syndrome,while 278 cases with primary asthenia-secondary sthenia syndrome,18 cases with excess syndrome.Comparing with RIF group and without RIF group:only with deficiency syndrome(0.5%vs3.5%).primary asthenia-secondary sthenia syndrome(93.5%vs90.6%)?excess syndrome(6%vs5.9%),There was no statistical difference in overall distribution of syndromes between the two groups(P>0.05)?(2)Deficiency syndrome:Distribution of the deficiency of this disease with RIF group and without RIF group:spleen and kidney qi deficiency(42.8%vs43.5%)?qi and yin deficiency type(21.4%vs30.6%)?liver and kidney yang deficiency(16.7%vsll.8%)?lung and kidney qi deficiency(10.2%vs12.9%)?spleen and kidney yang deficiency(7.0%vs1.2%)?The proportion of spleen and kidney yang deficiency in RIF group was higher than that in RIF group,that had statistically significant differences(P<0.05),and there was no significant difference between the other syndromes(P>0.05).(3)Superficiality excess syndrome:The empirical distribution of RIF group with and without RIF group:water-dampness(85.6%vs72.9%).blood stasis(64.7%vs41.2%)?dampness-heat(45.6%vs35.3%)?qi stagnation(0.5%vs1.2%)?wet cloud(0.9%vs0.0%),Comparison between the two groups found that the proportion of water-dampness syndrome and blood stasis syndrome in the RIF group was significantly higher than that in the RIF group,with significant statistical differences(P=0.010,0.000,P<0.05).Statistical differences(P>0.05).3.Basic materials(1)Gender:Of the 300 IMN patients who met the inclusion criteria,165(55%)were men and 135(45%)were women.n the renal interstitial fibrosis group,there were 118 males(54.9%)and 97 females(45.1%);no renal interstitial fibrosis group,including 47 males(55.3%)and 38 females(44.7%),there was no statistical difference in gender composition between the two groups(P>0.05).(2)Age:The age of renal puncture with renal interstitial fibrosis group was 54.48± 11.77(years),42.55±13.17(years)without renal interstitial fibrosis group,and the average age of renal interstitial fibrosis group was larger.There was no statistical difference between the two groups(P>0.05).(3)Course of the disease:The duration of renal interstitial fibrosis with and without renal interstitial fibrosis was 5.0(9.0)vs 3.0(8.5)months,respectively,with a longer course of renal interstitial fibrosis,with statistically significant differences between the two groups(P<0.01).4.Clinical situation(1)Hypertension:There were 148 cases(68.8%)with renal interstitial fibrosis and 35 cases(41.2%)without renal interstitial fibrosis,with significant differences between the two groups(P<0.01).(2)Other complications:Comparing comorbidities with RIF group and without RIF:type 2 diabetes(18.1%vs 12.9%),hyperuricemia(18.1%vs 14.1%),dyslipidemia(69.8%vs67)1%),arteriosclerosis(13.0%vs 8.2%),there was no statistical difference between the two groups(P>0.05).5.Pathological features(1)Plasma Albumin(Alb):The average level of Alb in the renal interstitial fibrosis group was 24.98±6.98g/L,and the average Alb level in the renal interstitial fibrosis group was 26.76±7.11 g/L.The renal interstitial fibrosis group was relatively low.No statistical difference(P>0.05);(2)Renal function:The indexes of renal function in RIF group and non-RIF group were compared:urea nitrogen(BUN)[5.40(2.33)vs 4.19(1.74)]u,ol/L,serum creatinine(Scr)[71.00(23.50)vs66.00(18.50)]mmol/L,Estimation of glomerular filtration rate(eGFR)[96.0(25.0)vs 109.0(24.5)]ml/min/1.73m2,with higher BUN and Scr in RIF group than in RIF group,eGFR Low,according to CKD stage analysis of eGFR,there was a significant difference between the two groups(P<0.01).(3)Other biochemical indicators:Compared with other biochemical indexes of RIF group and non-RIF group:uric acid(UA)was[365.30±100.17vs350.39±193.62]umol/L,and alanine aminotransferase(ALT)was[15.0(11.0)vs16.4(11.0).]mmol/L,aspartate aminotransferase(AST)was[19.5(7.80)vs19.0(7.75)]mmol/L,transpeptidase(y-GT)level was[20.0(13.0)vs18.4(13.95)]mmol/L,cholesterol(CHO)level[7.0(2.61)vs 7.20(2.30)]mmol/L,triglyceride(TG)level[2.22(1.69)vs 1.99(1.46)]mmol/L,high density The level of bottom lipoprotein(HDL-C)is[1.43(0.59)vs 1.40(0.66)]mmol/L,and the level of low-density lipoprotein(LDL-C)is[4.32(1.89)vs 4.51(1.72)]mmol/L.There was no statistical difference between the two groups in the above indicators(P>0.05).(4)Urine protein quantification:Quantitative comparison of urinary protein in RIF group and non-RIF group:24h urinary protein quantification was[3720.0(3036.00)vs 3420.00(2955.25)]mg/24h,and nephrotic range proteinuria was defined as 24-hour urinary protein>3.5g/24h.(44.20%vs 40.0%).The urinary protein quantification was higher in the RIF group than in the RIF group.There was no statistical difference between the two groups(P>0.05).(5)Urine red blood cell count ?10/HP:The proportion of urine red blood cell count ?10/HP with RIF group and non-RIF group was 32.1%vs 29.4%,there was no statistical difference between the two groups(P>0.05).6.Pathological data(1)Pathological stage:The pathological stages of the renal interstitial fibrosis group and the non-renal interstitial fibrosis group were mainly in the stage ? and stage ?.The two groups were in stage I membranous nephropathy[45.0%vs 47.6%],and the ?-? stage membranes.Nephropathy[19.4%vs28.0%],stage ? membranous nephropathy[26.1%vs 19.5%],stage II-III membranous nephropathy[7.6%vs 3.7%],stage III membranous nephropathy[3.6%vsl There was no stage IV membranous nephropathy in.2%],and there was no statistical difference between the two groups(P>0.05).(2)Diverse immune complexes:The proportion of immune complexes in RIF group and non-RIF group was 46.1%vs 57.3%.The proportion of RIF group was lower than that in RIF group.There was no significant difference between the two groups(P>0.05).(3)Glomerular lesions:The proportion of glomerular mesangial lesions in the RIF group and non-RIF group was 90%(45.6%vs 50.6%)in the mesangial cells and stromal hyperplasia.The RIF group was lower in the RIF group than in the RIF group.There was no statistical difference(P>0.05).(4)Glomerular Sclerosis:The proportion of glomerular sclerosis in patients with and without RIF group:ischemic sclerosis(37.2%vs 18.8%),crescent formation(13.5%vs.1.2%),spheroidiscosis(18.6%vs5.9%),staged hardening(4.7%vs.1.2%).There was an ischemic sclerosis in the RIF group,and the crescent moon was less in the RIF group than in the RIF group.There was a statistical difference between the two groups.No other sclerosis was statistically significant(P>0.05).(5)Tubular lesions:Incidence of renal tubular lesions in the RIF group and non-RIF group:epithelial vacuolization and granulotrophy(91.5%vs 77.6%),focal atrophy(90.2%vs 7.1%),renal involvement in the RIF group Tumor atrophy was significantly higher in the small group than in the non-RIF group.There was a significant difference between the two groups(P<0.01).(6)Renal arteriopathy:The proportion of renal arterioles lesions with RIF group and without RIF group was compared:no obvious lesions(7.0%vs 45.2%),hyaline lesions(5.1%vs 2.4%),luminal stenosis(0.9%)Vs 1.2%),thickened wall(92.1%vs 59%).No obvious lesions in the RIF group were significantly lower than those in the non-RIF group,and the proportion of wall thickening was significantly higher than that of the non-RIF group.There was no statistically significant difference between the two groups and the wall thickness was significantly different(P<0.01),other lesions were not statistically different(P>0.05).ConclusionCompared with non-RIF idiopathic membranous nephropathy,IRF idiopathic membranous nephropathy has the following characteristics:(1)With edema and foamed urine as the main symptoms,syndromes of traditional Chinese medicine were characterized by spleen and kidney qi deficiency syndrome,wetness syndrome,and blood stasis syndrome.(2)Clinical men are more common,urinary protein quantitation is high,often accompanied by hypertension,and the underlying renal function is poor;(3)The incidence of glomerulosclerosis,renal interstitial inflammatory cell infiltration,and renal arteriosclerosis are high. |
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