Characteristics Of Glomerular Sclerosis Proportion And Its Correlation With Prognosis In Patients With Idiopathic Membranous Nephropathy

Objective :To investigate the clinical-pathological features and prognosis of idiopathic membranous nephropathy(IMN)with different degrees of glomerular sclerosis.Methods A total of 200 patients,who were diagnosed as idiopathic membranous nephropathy by renal biopsies from January 2008 to December 2017 in our hospital were enrolled.Finally,there were a total of 141 patients with complete follow-up data.All patients were divided into two groups according to the optimal cut-off level of glomerular sclerosis proportion in the receiver operating characteristic curve(ROC)as follows: <6.45%;?6.45%.Comparing the clinical pathology and prognosis between the two groups.Follow-up endpoint: e GFR decreased by 20%;ESRD or all-cause death.Kaplan-Meier curve and cox regression model were used to analysis the renal survival among two groups.Results: Among the 200 patients,116 patients(58%)with glomerular sclerosis,7 patients(3.5%)with FSGS,64 patients(32%)with glomerular sclerosis and 13 patients(6.5%)with FSGS and glomerular sclerosis.There were 84 cases with glomerular sclerosis,accounting for 42%.In 141 patients with IMN with complete follow-up data,there were 100 cases(70.9%)with glomerular sclerosis proportion<6.45% and 41 cases(29.1%)with glomerular sclerosis proportion ?6.45%.(1)clinical characteristic: Patients with glomerular sclerosis proportion ?6.45%,had higher level of blood urea nitrogen?serum creatinine and triglyceride,but lower e GFR.(2)Pathological characteristic:Compared with those glomerular sclerosis proportion <6.45%,patients glomerular sclerosis proportion ?6.45% had more severe renal pathology.They had higher proportion of renal interstitial inflammatory cell infiltration,tubular atrophy and renal arteriolar thickening.(3)Related analysis: age,CKD stage,renal interstitial inflammatory cell infiltration,tubular atrophy,renal arteriolar thickening were positive related to glomerular sclerosis proportion.e GFR was negative related to glomerular sclerosis proportion.However,there were no significant correlation between glomerular sclerosis proportion and systolic blood pressure and diastolic blood pressure.(4)Logistic regression analysis: Logistic regression analysis showed that tubular atrophy and renal interstitial inflammatory cell infiltration were independently related factors in the formation of glomerular sclerosis in patients with IMN patients.(5)Patients with glomerular sclerosis proportion?6.45% were significantly associated with worse renal function and prognosis.Cox regression analysis show that as the proportion of glomerular sclerosis increases,the risk of renal outcomes increases gradually.(6)Patients were followed-up for a median of 35.6±26.1 months,Kaplan-Meier analysis revealed that renal survival rate was significantly lower in patients with glomerular sclerosis proportion ?6.45% compared with another group.Cox regression analysis show that as the proportion of glomerular sclerosis increases,the risk of renal outcomes increases gradually.In patients with e GFR ?90 ml/min,as glomerular sclerosis proportion rose for 1 %,the risk of renal outcomes increases for 3%.Conclusions: glomerular sclerosis proportion is negatively correlated with e GFR in patients with IMN and positively correlated with age.Tubular atrophy and renal interstitial inflammatory cell infiltration were risk factors for the formation of glomerular sclerosis.Patients with glomerular sclerosis proportion?6.45% were significantly associated with worse renal function and prognosis.Cox regression analysis show that as the proportion of glomerular sclerosis increases,the risk of renal outcomes increases gradually.