| Objective: To investigate the clinical and pathological features of young patients with idiopathic membranous nephropathy and the relationship between serum anti-PLA2 R antibody levels and prognosis of IMNMethods: This study was a retrospective cohort study,in which 1137 IMN patients with complete clinical pathology were diagnosed by renal biopsy from 2017-03-01 to 2018-08-31 in our hospital.They were divided into young group(?44 years old)and middle-aged group(>44 years old)according to their age,in order to compare the clinical and pathological features and PLA2R-Ab concentration in serum of the two groups.Among them,398 patients with IMN who were followed up for more than 6 months were involved in comparison of the treatment response rate between the young and middle-aged groups.97 patients of the follow-up were examined with PLA2 R and periodic serum PLA2R-Ab to analyze the role of PLA2R-Ab changes in the course and outcome of young and middle-aged IMN patients.The concentration of PLA2R-Ab was determined by ELISA and the PLA2 R antigen was detected by high temperature repair and Immunohistochemistry.Results:1.Among 1137 patients with IMN,the middle-aged occupied 66.40%.The male to female ratio was approximately 1.63:1,with an average age of 49.03±12.72 years,ranging from 18 to 79 years.2.The course of young IMN patients was shorter than that of middle-aged and elderly people,and the proportion of hypertension and eGFR decreased was lower(P<0.01).The PLA2R-Ab titer was significantly lower than that of middle-aged and elderly group(99.86±160.36KRU/Lvs140.87± 228.92KRU/ L,P<0.01),the proportion of renal pathological stage IV was higher than that of middle-aged group(1.83% vs 0.26%,P<0.01),glomerular sclerosis and tubulointerstitial lesions were lighter(P<0.05 or 0.01).3.Patients with high titer PLA1R-Ab(?154.48KRU/L)among 1137 patients with IMN owns lower levels of ALB and eGFR(P<0.05),and the 24-hour urine protein level was higher(P<0.05).Linear correlation analysis showed that PLA2R-Ab titer was negatively correlated with ALB level(r=-0.184,P<0.01).There was a positive correlation with urinary protein quantification(r=0.197,P<0.01)and no correlation with serum creatinine(r=0.065,P=0.067).4.There was no significant difference in the remission rate between young and middle-aged IMN patients after 6 months of follow-up(P>0.05).5.After treatment of the young and middle-aged groups,the PLA2R-Ab(P<0.01)titer decreased with the remission of the disease.6.The change degree of PLA2R-Ab titer was related to prognosis,and the rate of remission was high(P<0.05),but not significantly correlated with age.Conclusion:Compared with middle-aged and elderly IMN patients,young patients possessed clinical characteristics including shorter course of disease,lower incidence of hypertension and eGFR decrease,and lower antibody titer of PLA2R-Ab.Renal pathology was mainly in stage I and II.Stage IV accounted for a higher proportion in young group,and glomerular sclerosis and tubulointerstitial lesions were milder in young group.There was no difference in recent remission rates between young group and middle-age group.Age is not a factor influencing the short-term prognosis of IMN patients.Patients with IMN who had a rapid decrease in PLA2R-Ab titer are more likely to achieve remission. |
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