Analysis Of Factors Influencing Prognosis Of Patients With Idiopathic Membranous Nephropathy

Objective:To investigate the factors influencing prognosis of patients with idiopathic membranous nephropathy(IMN).Methods:Patients who were diagnosed with IMN by renal biopsy for the first time in the Department of Nephrology in the First Affiliated Hospital of Fujian Medical University from January 1,2010 to December 31,2016 were enrolled in this retrospective study.All patients were 14 or even older and followed up for more than12 months.This study excluded patients who had the secondary glomerular disease,other renal complications,severe cardiopulmonary dysfunction,and patients who were associated with end stage renal disease[ESRD,estimated glomerular filtration rate(eGFR)<15 ml/min/1.73m~2,dialysis,kidney transplant],and patients who were followed up for less than 12 months or with incomplete follow-up information.The end-point of the study included:the decrease in eGFR(a decline in GFR grading,with a decrease of 25%or more in eGFR from baseline),a doubling of serum creatinine(the final serum creatinine was twice the baseline serum creatinine or more),ESRD.Patients were devided into two groups(one group of stable renal function and the other group of progressive renal function)according to whether end-point occurred during the follow-up.The baseline data of patients at renal biopsy was collected and analyzed to explore the factors influencing the prognosis of IMN.If the factors were proved to be associated with the prognosis of IMN independently,we would evaluate its predictive value and calculate the best predictor by the receiver operating characteristic curve.The patients were regrouped according to the best predictor.The cumulative risk rate of the two groups were compared by the Kaplan-Meier curve.Results:A total of 94 patients were diagnosed with IMN by renal biopsy in the Department of Nephrology in the First Affiliated Hospital of Fujian Medical University during January 1,2010 to December 31,2016 and they were followed up regularly.Renal function progression occurred in 17(18.09%)patients,while 77(81.91%)patients'renal function remained stable.Among patients in renal function progression group,2 patients emerged end-point that GFR grading declined with eGFR decreased 25%or more from baseline,and 7 patients emerged the doubling of the serum creatinine,and 8 patients emerged ESRD(2 cases of hemodialysis,6 cases of eGFR<15 ml/min/1.73m~2).Significant difference was showed in 11 variables including age,hypertension,mean arterial pressure,nephrotic syndrome,the hemoglobin concentration,the hematocrit,the serum creatinine,the serum urea nitrogen,eGFR,fibrinogen and tubulointerstitial lesions between two groups by univariate analysis(P<0.05).Mean arterial pressure(OR=1.093,95%CI 1.022-1.169)and eGFR(OR=0.939,95%CI 0.901-0.978)were showed to be independently correlated with renal function progression in IMN by binary logistic analysis.The receiver operating characteristic curve indicated the good ability of mean arterial pressure and eGFR to predict the progress of renal function in IMN.The best predictor of mean arterial pressure was 109.33 mmHg,and that of eGFR was 94.72ml/min/1.73m~2 by calculating the most Youden index.94 patients were regrouped respectively according to the best predictors of mean arterial pressure and eGFR.Survival analysis showed that the cumulative risk of renal function progression in high mean arterial pressure group was higher than that in low mean arterial pressure group(P<0.001),and the cumulative risk of renal function progression in low eGFR group was higher than that in high eGFR group(P<0.001).Conclusions:Mean arterial pressure and eGFR are independently correlated with the prognosis of patients with IMN;Mean arterial pressure and eGFR have predictive value for renal function progression in patients with IMN;Patients with high mean arterial pressure or low eGFR are more likely to have renal function progression.