| Objective:1.The clinicopathologic data of patients with idiopathic membranous nephropathy（IMN）initially diagnosed by multi center transrenal biopsy were retrospectively analyzed and grouped according to the pathological stage to compare the clinicopathologic characteristics and related risk factors in each group.2.To investigate the efficacy and safety of Kunxian capsule in the treatment of IMN patients.Methods:1.The general data,renal pathology and laboratory tests of patients initially diagnosed with IMN by transrenal biopsy in the Nephrology Department of some tertiary hospitals in Jilin Province from September 2016 to September 2021 were collected,and the clinicopathological characteristics of patients with different pathological stages were retrospectively analyzed.2.The clinicopathologic data of 42 patients with IMN diagnosed by renal pathology and treated with Kunxian capsule from September 2016 to September 2021 in the Nephrology Clinic of the Second Hospital of Jilin University were collected and divided into the conventional refractory group according to the condition.Record the changes of laboratory parameters and the occurrence of adverse reactions during medicationResult:1.Comparison of clinicopathological data of IMN patients with different pathological stages（1）Basic clinical data of IMN patients with different pathological stagesThis study included 602 IMN patients,379 males and 223 females,for a male to female ratio of 1.7:1.The difference was statistically significant（P<0.05）.In comparison to the stage Ⅰ group,the stage Ⅱ group had more individuals with nephrotic syndrome（P<0.05）.IMN patients with stage Ⅱ and Ⅲ-Ⅳ had significantly lower serum albumin and serum calcium levels than IMN patients with stage Ⅰ,and urine red blood cells were more common in IMN patients with stage Ⅰ and Ⅱ than in IMN patients with stage Ⅲ-Ⅳ（P<0.05）.（2）Pathological data of IMN patients with different pathological stagesIn this study,the positive rate of C3 deposition in stage Ⅰ IMN patients was significantly lower than that in stage Ⅱ and Ⅲ-Ⅳ（P<0.05）,and the positive rate of Clq deposition in stage Ⅲ-Ⅳ IMN patients was significantly higher than that in stageⅠ（P<0.05）.Tubular focal atrophy and renal interstitial foam cell formation were more pronounced in the stage Ⅲ-Ⅳ group than in the stage Ⅰ group,and hyalinization was more pronounced than in the stage Ⅰ and Ⅱ patients（P<0.05）.Patients with stage Ⅱand Ⅲ-Ⅳ IMN had more significant renal interstitial focal edema,focal fibrosis,inflammatory cell infiltration formation,and arterial wall thickening than those with stage Ⅰ IMN（P<0.05）.（3）Multivariate logistic regression analysis of renal function progression in IMN patientsMultivariate logistic regression analysis showed that advanced age（≥60 years）,with hypertension,hyperuricemia and inflammatory cell infiltration were independent risk factors for renal function progression in IMN patients（P<0.05）.2.Application study of Kunxian capsule in idiopathic membranous nephropathy（1）Comparison of the general data of patients in the conventional groupIn the conventional group,a total of 53 patients with IMN were enrolled,with 21 in the treatment group and 32 in the control group.In terms of demographic data,baseline clinical parameters,and renal pathology scores,there was no statistically significant difference between the two groups of patients（P>0.05）.（2）Comparison of observation indicators between the two groups in the conventional groupThe 24h urinary protein quantitative level in the treatment group was significantly lower than before treatment and in the control group at each time point,and the albumin level in the treatment group at 6 months of treatment was statistically different from that at 1 and 3 months of treatment（P<0.05）.The 24-hour urinary protein quantitative level in the control group was significantly lower after 6 months of treatment compared to before treatment,the albumin level was higher at each time point than before treatment,and the albumin level at 3 months of treatment was significantly higher than in the treatment group（P<0.05）.（3）Comparison of clinical efficacy and adverse reactions between the two groupsAfter 6 months of treatment,the effective rate in the treatment group was 85.71 percent,while in the control group it was 56.25 percent.The treatment group’s clinical efficacy was substantially higher than the control group’s（P<0.05）.The treatment group’s rate（61.9%）of adverse responses was statistically different from the control group’s rate（31.3%）（P<0.05）.（4）Comparison of general data and observation indicators before and after treatment in the refractory groupThe refractory group consisted of 21 patients with IMN,including 11 patients（52.38%）who received standardized hormone combined with immunosuppressive agents for more than 6 months without remission of clinical symptoms,6 patients（28.57%）who relapsed after remission,and 4 patients（19.05%）who were steroid-dependent.The total cholesterol level was significantly lower after 3 months of treatment（P<0.05）,the urine red blood cell count was significantly lower after 3 and 6 months of treatment（P<0.05）,and the urinary red blood cell count at 3 months of treatment was the lowest level during treatment（P<0.05）.（5）Evaluation of clinical efficacy and adverse reactions in the refractory groupIn the refractory group,12 of the 21 IMN patients reported adverse responses.Although the symptoms improved dramatically after active symptomatic therapy,blood creatinine levels in two patients did not return to normal at the end of the research.The overall clinical response rate was 90.48 percent after 6 months of treatment.Conclusion:1.The incidence of idiopathic membranous nephropathy is slightly higher in males than in females,and the clinical manifestations are mainly nephrotic syndrome.Factors such as hypertension,serum albumin level,serum calcium level,urine red blood cell count level,and the presence of serum anti-PLA2R antibodies are closely related to the pathological stage.2.The pathological type of patients with idiopathic membranous nephropathy is mainly stage II,and immunofluorescence is dominated by IgG deposition,which may be accompanied by C3 deposition.Advanced age,hypertension,hyperuricemia and renal interstitial inflammatory cell infiltration are independent risk factors for the progression of renal function in patients with IMN.Renal biopsy should be performed as early as possible in such patients in clinical practice to clarify the treatment plan.3.In the treatment of IMN patients with moderate proteinuria and refractory IMN patients with Kunxian capsule,the early clinical symptom relief effect is significant,which can effectively improve the serum albumin and 24-hour urinary protein quantitative level,safe and reliable,and has a good application prospect in the treatment of IMN in the future. |
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