Renal Ultrapathological And Clinic Pathological Analysis Of Idiopathic Membranous Nephropathy

Objective: To analyze and compare the clinical manifestations and renal pathological ultrastructure of 79 patients with idiopathic membranous nephropathy,which provided more evidence for correct diagnosis,treatment and prognosis evaluation.method: A number of 79 patients of renal biopsy-proven IMN in the first affiliated Hospital of Guangxi Medical University from January 2014 to December 2017 were involved,and the renal biopsy specimens were examined with light microscope,transmission electron microscope and immunefluorescence.Retrospectively analyzed the general information(age,sex,height,etc.),clinical manifestations(hypertension,edema,hematuria under microscope,24 hours urine protein,etc.),the results of renal pathology(ratio of glomerulosclerosis,thickness of glomerular basement membrane,etc.).Divid the patients into different groups according to different clinical manifestations and laboratory examinations.All patients were followed up by out-patient review or telephone for at least 6 months b to track of and comparet the clinical remission of patients after treatment.Results:(1)79 IMN cases were involved,elderly people were inclined to IMN and the average age was(45.89±12.97)years old with male and female prevalence ratio of 1.13: 1.All the 79 IMN cases were associated with proteinuria at the time of renal biopsy,71 cases had the clinical manifestations of NS which accounted for 89.87 %,74 cases had the clinical manifestations of edema which accounted for 93.67 %,while 22 cases were accompanied by hypertension which accounted for 27.85 %.35 cases were accompanied by microscopic hematuria which accounted for 44.30 %.All cases were not found with macroscopic hematuria.(2)79 IMN cases’ renal biopsy pathological types were classified as stage I-II,which accounted for 88.61 %,while stage III and IV were rare,respectively accounted for 7.59 and 3.8 %.Immunofluorescence deposition in glomeruli was mainly composed by IgG(97.47 %)and C3(97.49 %),while 5.06 % of them with IgM deposition,1.27 % of them with IgA deposition and 1.27 % of them with C1 q deposition.34 IMN cases were accompanied by glomerulosclerosis(43.04 %),by FSGS(1.27 %),by tubulointerstitial lesions(67.09 %),by mesangial proliferation(51.89 %),and 3.80 % of them appeared crescent.(3)The size of electron dense deposition: The differences of FIB,TP,tubulointerstitial lesions and thickness of basement membrane between the area groups are statistically significant(P < 0.05).(4)The remission rate after treatment in the small group was higher than the large group,and is statistically significant(P < 0.05).Conclusions:(1)79 cases of IMN are inclined to middle-aged and elderly people,and male groups have a relatively higher prevalence.IMN mainly performs asNephrotic Syndrome,accompanied by microscope hematuria.Renal pathological types of the cases were given priority to stage I and stage II.The immunofluorescence examination shows that depositions of IgG and C3 are mainly found.(2)The size of electron dense deposition was related to Serum total protein,fibrinogen,renal tubular interstitial lesions,and basement membrane thickness,but was not related to the level of proteinuria in IMN patients.(3)The size of electronic dense deposition was related to the prognosis of patients with IMN.