The Study Of Clinical Characteristics And Related Risk Factors Of Idiopathic Membranous Nephropathy Complicated With Infectious Diseases

Objective:To investigate the clinical characteristics and risk factors of idiopathic membranous nephropathy(IMN)infection.Methods:This investigation samples include all the patients diagnosed with IMN according to the KDIQO Guidelines(2012),who was hospitalized in department of nephrology,General Hospital of Northern Theater Command during Oct.2015 to Oct.2018.Base on the result of imaging examination,pathogenic microorganism examination and other clinical laboratory examinations,the patients were divided into infection group and non-infection group.This article will separately discuss the influence on the patients with IMN brought by age,sex,site of infection,serum albumin,globulin,24-hour urinary protein quantification,serum creatinine,blood urea,cystatin C,endogenous creatinine clearance rate,CRP,CD4+T lymphocyte,course of glucocorticoid therapy and cumulative dose,course of immunosuppressive therapy and cumulative dose.The t-test,rank sum test,chi-square test,Fisher exact test and other statistical methods will be used respectively according to data distribution characteristic.And SPSS 24.0 statistical software was used to analyze the influence differences between groups.The ROC curve was used to analyze the predictive value of serum albumin,CD4+T lymphocyte,CRP and creatinine clearance rate about the IMN infection.Results:This research included 193 patients.The proportion of men and women is 174:19 age distribution and middle age was 55years old.The patients were divided into infection group with 41 cases(21.24%)and non-infection group with 152 cases(78.76%),based on whether infection occurred during kidney diseases diagnosis and treatment.The commonest type of infection was pulmonary infection with 31 cases(75.6%).During treatment,23 cases(1 1.92%of the total sample and 13.14%of the glucocorticoid samples)developed new onset diabetes.Serum albumin was 26.5±1.364 in infected group and 32.04±0.6451 in non-infected group,P=0.0002.CD4+T lymphocyte was 703(503.5,1045)and 894.5(672,1182.75),P=0.007 in infected group and non-infected group respectively.Serum creatinine was 75(66.5,94)and 71(62,79),P=0.008 in infected group and non-infected group respectively.The creatinine clearance rates were 84.12+5.312,96.63+2.508,P=0.0256,suggesting the difference between two groups had statistical significance.The use of glucocorticoids,cyclophosphamide and other drugs in the infected group and non-infected group had statistical difference,but the results were negatively correlated.Conclusion:Pulmonary infection is a common type of infection during IMN diagnosis and treatment.IMN combined with hypoalbuminemia and CD4+T lymphocyte decrease were risk factors of infection.For glucocorticoids,immunosuppressants and other drugs that may induce infection,standardized application in the early stage of nephropathy can control disease condition as soon as possible.The application can alleviate clinical indicators such as massive proteinuria and hypoalbuminemia,then control the occurrence of infection.