Clinicaland Pathologicalanalysis Of Anca-associated Glomerulonephritis With Membranous Nephropathy-like Pathology-a Single-center Retrospective Study

Objective: To compare the clinical features of patients with membranous nephropathy(MN)-like pathological changes and anti-neutrophil cytoplasmic antibody-associated(ANCA-GN)patients without MN(oligoimmunocomplex),histological features and differences in prognosis.Methods: A retrospective analysis of 54 cases of primary anti-neutrophil cytoplasmic antibody-associated glomerulonephritis(ANCA-GN)diagnosed by endovascular biopsy from the First Affiliated Hospital of Guangxi Medical University from January 2008 to January 2019 Patients,according to renal pathological immunofluorescence results were divided into IgG,C3 along the glomerular basement membrane cis-granular deposition(intensity > 1 +)membranous nephropathy-like patients(12 cases),and oligo immune complex deposition Patients with non-membranous nephropathy(42 cases);differences inclinical features,laboratory tests,renal pathology,treatment,and prognosis between the two groups.Results : Of the 54 patients diagnosed with primary anti-neutrophil cytoplasmic antibody-associated glomerulonephritis,there was no difference in gender composition between the oligo-immune complexes without MN,and the MN-like pathological changes group.Male-dominated;compared with ANCA-GN patients who did not have MN oligo-immune complexes,the ANCA-GN group with MN-like pathology had higher 24 h urinary protein levels,lower albumin levels,and a higher level of initiality.Serum creatinine,serum ferritin,and Birmingham scores;however,C-reactive protein and erythrocyte sedimentation rate were higher in patients with oligo-immune complexes without MN(P < 0.05).Patients with ANCA-GN combined with MN-like pathological changes showed MPO type in ANCA serotype analysis,and PR3 type only appeared in patients with oligoimmunocomplex without MN,but the difference in serotype and titer The comparison was not statistically significant between the two groups.In the comparison of renal histopathology,the ratio of spherical sclerosis in the ANCA-GN combined with MN-like pathological changes was lower than that in the oligo-immunized complex without MN(P=0.030),but in the cellular crescent,fibrin There were no significant differences between the two groups in the necrosis,mesangial hyperplasia score,tubular atrophy score and interstitial fibrosis score.Kaplan-Meier survival analysis showed that the survival rate of ANCA-GN combined with MN-like pathological changes was lower in the oligo-immunocomplex group without MN(log-rank=4.544,P=0.033);There was no significant difference in renal survival between the two.Conclusions: 1.The majority of patients with ANCA-GN and MN-like pathological changes were predominantly male.2.In the ANCA-GN group with MN-like pathological changes,renal damage was more severe and the mortality was higher compared with those with ANCA-GN but without MN.