| Objective: Idiopathic membranous nephropathy is the most common cause of adult nephrotic syndrome,with lots of serious complications and difficulties in healing.The pathogenesis and prognostic factors of idiopathic membranous nephropathy are not very clear.The aim of the study is to explore the prognosis and influencing factors of the disease when treated with conservative methods.Methods: 78 patients with idiopathic membranous nephropathy diagnosed by renal biopsy in Yuhuangding Hospital of Yantai from January 2015 to December 2017 were selected as low-risk group and initially treated conservatively.A total of 78 patients were followed up regularly for at least 12 months.According to the aggravation of patients' condition during the follow-up period,42 patients were treated with immunosuppressive therapy.The Non-immunotherapy group(36 cases)was the Non-immunotherapy group.According to the results of serum albumin and 24-hour proteinuria after regular treatment.The Non-immunotherapy group was divided into Non-immunotherapy remission group(30 cases)and Non-immunotherapy remission group(6 cases).The basic information of patients,renal pathology,urine,serological indicators and other clinical data were collected.According to statistical analysis,the prognosis and influencing factors of Non-immunotherapy of idiopathic membranous nephropathy in low-risk group were studied.Results: 1.A total of 78 patients with idiopathic membranous nephropathy in low-risk group were enrolled in the study,with an average age of 44.42 ± 11.93 years.There were 37 males(47.4%)and 41 females(52.6%).During 12 months of follow-up,38 cases had complete remission,22 cases had partial remission and 18 cases had no remission.During the follow-up period,42 cases were transferred from Non-immunotherapy to immunosuppressive treatment group,In the first six months,there were 30 cases,accounting for 71.4%.2.According the comparing results of the baseline data of the two groups,the levelsof total protein,albumin and serum IgG in the conservative group were higher than those in the immunosuppressive group,while the levels of age,urinary IgG,mounts of 24 H urinary protein,total cholesterol,triglyceride,the fluorescent C3 deposition grade,tubular atrophy and interstitial inflammatory fibrosis gradel of the conservative group were lower than those of the immunosuppressive group(The P value of the two groups was < 0.05,with significant difference).3.The serum albumin levels of the two groups were followed up in 1st,2nd,3rd,6th and 12 th month.no statistical difference(P > 0.05).4.Compared with the baseline data of the remission group and the non-remission group,the degree of renal interstitial lesion in the remission group was lighter than that in the immune group.Compared with the two groups,the P value was < 0.05,and the difference was statistically significant.5.A multivariate logistic regression analysis was performed on 78 patients.Increased serum IgG(P = 0.021,HR = 0.809)at renal biopsy was an independent protective factor for complete remission of IMN in low-risk group at 12 months.More C3 deposition in renal tissue(P=0.043,HR=0.539)and more severe renal interstitial lesions(P=0.046,HR=-0.435)were independent risk factors for complete remission of IMN patients in low-risk group at 12 months.Conclusion: 1.Delayed immunosuppressive therapy has no effect on short-term prognosis in low-risk IMN patients.We should strengthen the early follow-up of patients with IMN in low-risk group and adjust the treatment plan in time.2.The level of total protein,albumin and serum IgG was higher in the low-risk group,age,urinary IgG,total cholesterol,triglyceride,C3 deposition in renal tissue,tubular atrophy and interstitial fibrosis were lower.The level of renal interstitial lesions in remission group was lower than that in non-remission group.3.Serum IgG,C3 deposition in renal tissue,tubular atrophy and interstitial fibrosis are independent predictors of 12-month prognosis in low-risk IMN patients treated with initial conservative therapy. |
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