| OBJECTIVE?This study aimed to investigate the pathological types and spectrum changes of chronic glomerular diseases,as well as the epidemiological characteristics of membranous nephropathy.?This study aimed to explore the prognostic prediction value of renal PLA2R and THSD7A antigens in idiopathic membranous nephropathy,and to analyze the association between renal autoantigens and the effects of different therapeutic schemes.?This study aimed to explore the prognostic prediction value of serum anti-PLA2R and anti-THSD7A antibodies in idiopathic membranous nephropathy,and to analyze the association between serum antibodies and the effects of different therapeutic schemes.METHODS?We retrospectively analysed the clinicopathologic data of patients performed renal biopsy in our center from January 2001 to December 2018,in order to investigate the pathological types distribution of chronic glomerular diseases and the epidemiological characteristics of membranous nephropathy.?We retrospectively analysed the clinicopathologic data of idiopathic membranous nephropathy in our center from September 2015 to November 2017,aiming to analyze the association of renal PLA2R and THSD7A antigen deposits with proteinuria remission and renal prognosis,as well as the association between renal autoantigens and the effects of different therapeutic schemes.?Patients diagnosed with idiopathic membranous nephropathy from December 2017 to July 2018 were enrolled in this prospective cohort study.Serum anti-PLA2R and anti-THSD7A antibodies were detected at baseline,the third months and the sixth months,in order to investigate the predictive value of serum anti-PLA2R and anti-THSD7A antibodies in clinical prognosis.Besides,the therapeutic effect was compared between cyclophosphamide and cyclosporine at different levels of serum autoantibody concentrations.The dynamic changes of serum antibodies were also compared between cyclophosphamide and cyclosporine.RESULTS?Among 6,366 patients performed renal biopsy,IgA nephropathy and lupus nephritis were the most common primary and secondary glomerular diseases,while membranous nephropathy and diabetic nephropathy were primary and secondary glomerular diseases with the fastest increasing frequency.The proportion of membranous nephropathy coexisted with metabolic diseases experienced an increasing tendency and membranous nephropathy was an independent risk factor for cardiovascular comorbidity.? Among 296 consecutive idiopathic membranous nephropathy patients enrolled between September 2015 and November 2017,the positive rates of renal PLA2R and THSD7A antigen were 77.7%and 2.9%.The deposit of renal PLA2R antigen was an independent risk factor for proteinuria remission(HR:1.531;95%Cl:1.038-2.258;P=0.032)and renal function prognosis(HR:2.668;95%CI:1.146-6.210;P=0.023)in patients with idiopathic membranous nephropathy.Patients with renal PLA2R antigen deposit had a lower rate of spontaneous remission.Among patients with positive renal PLA2R antigen deposit,cyclophosphamide experienced a higher long-term remission rate than cyclosporine(Logrank test,P=0.022).?Among 85 idiopathic membranous nephropathy patients enrolled from December 2017 to July 2018,the positive rates of serum anti-PLA2R and THSD7A antibodies were 70.6%and 22.4%.Higher serum anti-PLA2R antibody was an independent risk factor for clinical remission in patients with idiopathic membranous nephropathy and the serum anti-PLA2R antibody was linearly related to baseline proteinuria,albuminuria,serum creatinine and serum albumin.The serum anti-PLA2R antibody and anti-THSD7A antibody concentration were closely related to the disease activity.There was no statistical difference in the remission rates of cyclophosphamide and cyclosporine at different concentrations of serum anti-PLA2R and anti-THSD7A antibodies.At the 3rd and 6th month,the serum anti-PLA2R antibody concentration in the cyclophosphamide group was lower than that in the cyclosporine group and the difference had statistical significance.CONCLUSIONSThe proportion of membranous nephropathy accounted for renal biopsy patients and the proportion of coexisting metabolic diseases in membranous nephropathy had been increasing.Membranous nephropathy increased risk for cardiovascular comorbidity.Idiopathic membranous nephropathy with renal PLA2R antigen deposit experienced lower remission rate and worse renal function.The long-term remission rate of cyclophosphamide was higher than cyclosporine in patients with renal PLA2R antigen deposit.The concentration of serum anti-PLA2R and anti-THSD7A antibody were closely related with the disease activity.Patients with higher concentration of serum anti-PLA2R antibody had lower remission rate.Cyclophosphamide was superior to cyclosporine in reducing serum anti-PLA2R antibody concentration.Patients treated with cyclophosphamide could achieve early serological remission. |
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