Correlation Between Plasma Fibrinogen And Idiopathic Membranous Nephropathy

ObjectiveMembranous nephropathy(MN)is a common cause of nephrotic syndrome(NS)in adults.The patients with NS often show hypercoagulable state,and are prone to form venous or arterial thrombosis.The increase of plasma fibrinogen(FIB)is an important characteristic of hypercoagulable state in the patients with NS.It is related to thrombosis,and is one of the important factors of aggravation,recurrence and protraction of the patients with NS.In this study,the patients with idiopathic MN were selected as the subjects,we discussed the relationship of plasma FIB to clinical features,pathological manifestations and therapeutic effects of MN in detail.MethodsWe collected the complete data of the patients with idiopathic MN who underwent renal biopsy from September 2012 to January 2018 in our hospital.The clinical and pathological data of the patient at the time of renal biopsy,and the data during follow-up were collected.According to the normal reference range of plasma FIB(2.00 g/L-4.00 g/L)in our hospital,all the patients were divided into three groups:the FIB 1 group(FIB:2.00 g/L-4.00 g/L),the FIB 2 group(FIB:4.01 g/L-6.00 g/L)and the FIB 3 group(FIB>6.00 g/L).We analyzed and compared the clinical features and pathological manifestations of each group,and explored the correlation of plasma FIB to clinical features,pathological manifestations and therapeutic effects.Results1.A total of 84 patients with idiopathic MN were enrolled in the study.There were 32 patients in the FIB 1 group,39 patients in the FIB 2 group,and 13 patients in the FIB 3 group.There were no significant differences in age,male-female ratio,mean arterial pressure,hemoglobin,and platelet count among the three groups.2.In the FIB 2 group,the median plasma FIB was 4.96 g/L,serum albumin and neutrophil counts were lower than those in the FIB 1 group,serum total cholesterol,low density lipoprotein cholesterol,erythrocyte sedimentation rate and high sensitivity C reactive protein(hs-CRP)were higher than those in the FIB 1 group.There were no significant differences in urine protein,serum creatinine,uric acid,estimated glomerular filtration rate(eGFR),globulin,triglyceride,high-density lipoprotein cholesterol,prothrombin time(PT),activated partial thromboplastin time(APTT)and lymphocyte counts between the two groups.3.In the FIB 3 group,the median plasma FIB was 6.92 g/L,serum albumin,eGFR and neutrophil counts were lower than those in the FIB 1 group,serum creatinine,total cholesterol,low density lipoprotein cholesterol,PT,erythrocyte sedimentation rate and hs-CRP were higher than those in the FIB 1 group,eGFR was lower than that in FIB 2 group,serum creatinine and hs-CRP were higher than those in the FIB 2 group.4.As the level of plasma FIB increased,the proportion of the patients with spheroid sclerosis,tubular atrophy,interstitial fibrosis,interstitial cell infiltration,and vascular disease increased gradually.The proportion of the patients with spheroid sclerosis,tubular atrophy,interstitial fibrosis,interstitial cell infiltration and vascular disease in the FIB 3 group was 84.6%,84.6%,84.6%,92.3%and 76.9%,respectively,higher than those in the FIB 1 group.5.There were no differences in the usage of hormones,immunosuppressive agents,renin-angiotensin blockers,anticoagulation,antiplatelet and lipid-lowering among the three groups.After 1 year of follow-up,the rate of complete remission in the FIB 3 group was only 7.7%(1 case),which was lower than that in the FIB 1 group and the FIB 2 group.There was no significant difference in the rate of partial remission and the rate of no remission.6.By correlation analysis,age,PT,APTT,erythrocyte sedimentation rate,hs-CRP,serum total,low-density lipoprotein cholesterol,creatinine and the proportion of the patients with spherocytosis,tubular atrophy,interstitial fibrosis,interstitial cells infiltration and vascular disease was correlated to plasma FIB positively,and neutrophil count,serum albumin and eGFR was correlated with plasma FIB negatively.ConclusionThe level of plasma FIB at the time of renal biopsy was closely related to the condition of the patients with idiopathic MN.The clinical manifestations and pathological changes were more serious in the patients with high level of plasma FIB.The level of plasma FIB at the time of renal biopsy was related to the disease remission after treatment,and the remission rate after treatment was lower in the patients with high level of plasma FIB.