A Single Center Retrospective Study Of High Risk Factors Of Airway And Prognosis Of Primary Membranous Nephropathy

Objective:explore the correlation between high risk factors of airway and PMN?prognosis of primary membranous nephropathy?.Methods:Patients with PMN diagnosed by renal biopsy were retrospectively analyzed from 2008 to 2018 in the Department of Nephrology,first affiliated Hospital of Dalian Medical University.Record demographic data,gender,age,blood pressure,time of initial diagnosis,residence,etc.The clinical laboratory indexes were respectively serum albumin,serum creatinine,24 hours urine protein quantity,serum uric acid,serum lipid?CH?TG?LDL-C?,serum anti-PLA ₂ R antibody and renal PLA ₂ R antigen in the same period of renal biopsy.Data on airway risk factors included online collection of average annual pm2.5concentrations,smoking history and lung disease in Dalian between 2013 and2018.In PMN patients were needed to have regular follow-up and complete follow-up records,the main follow-up endpoints were complete remission and partial remission,and secondary follow-up was on the day of deterioration of renal function?glomerular filtration rate decreased by 30%or entered into ESRD?.All the patients were firstly followed up monthly.Simultaneously,the PMN patients with complete remission were followed up once every 3 months.PMN patients were divided into three groups:CR,PR and NR according to the efficacy.For the continuous variables with normal distribution,t-test or one-way anova was used to compare the data between groups.Counting data comparison using chi-square test,bilateral p<0.05 is statistically significant.Cumulative remission rate was analyzed by kaplan-meier curve and COX regression was used to analyze the effect of high risk factors on prognosis.Results:From 2008 to 2018,a total of 2,509 patients underwent renal biopsy and puncture in our department,including 2,058 patients with primary renal disease,accounting for 82.0%.Among them,781 cases of IgA nephropathy,accounting for 31.13%,and 686 cases of membranous nephropathy,accounting for 27.34%of renal biopsy and puncture cases during the same period,second only to IgA nephropathy.A total of 581 patients were diagnosed with PMN,including 343 males?59.0%?and 238 females?41.0%?,with a male to female ratio of 1.4:1.The median age of onset was 56?10-76?years for males and 55?17-75?years for females.The age and gender distribution of PMN patients was characterized by a high proportion of patients in the 40-60 group,and no statistical difference was found between the age and gender groups.Taking every3 years as a cycle,the proportion of PMN in renal biopsy puncture in the same period was 18.6%,20.1%,25.5%and 27.8%,respectively.There were 368 cases?63.3%?of PMN patients whose urine protein content was greater than3500mg/24h,and 36 cases?6.2%?of PMN patients whose urine protein content was less than 1000mg/24h.The median follow-up was 14?6-40?months.In addition,40 cases?38.1%?had complete remission,45 cases?42.9%?had partial remission,and 20 cases?19%?had no remission.In addition,1 patient developed end-stage Renal Disease?ESRD?and finally started hemodialysis treatment,2cases were diagnosed with lung cancer during follow-up,and 1 patient was diagnosed with Sjogren's disease.Single-factor survival analysis of clinical baseline data in each group showed no statistically significant differences in gender,age,serum creatinine,serum uric acid,total cholesterol,triglyceride,low-density lipoprotein and treatment regimen,serum anti PLA₂R antibody and renal PLA₂R antigen?P>0.05?.However,24-hour urine protein quantification?P=0.008?was negatively correlated with the prognosis,while serum albumin?P=0.008?was positively correlated with the prognosis.Statistical analysis of the data of 581 cases of PMN patients in their residential areas and other urban areas reveals that the incidence rate of Shahekou District is the highest,which accounts for 2.33 per 10,000 cases,followed by xigang district,which accounts for 1.54 per 10,000 cases,and the lowest in lushunkou district,which accounts for 0.83 per 10,000 cases.The PM2.5 concentration?52.64 g/m3?during the heating period was higher than that during the unheating period?30.3 g/m3?,and the number of PMN patients during the heating period?146 cases?was slightly higher than that during the unheating period?136 cases?.Univariate analysis showed that lung disease was associated with the prognosis of PMN,and the smoking history of pm2.5,was not associated with prognosis?p>0.05?.At the same time,smoking and lung disease were associated with two high-risk factors of airway associated with prognosis?HR=3.729,P=0.045,95%CI:1.031-13.488?.Conclusion:Lung diseases are negatively correlated with the prognosis of PMN,and smoking and lung diseases are independent risk factors for poor prognosis of PMN.Both smoking and lung disease are independent risk factors for poor prognosis of PMN.