| Objective:To investigate the clinical and pathological fatures of idiopathic membranous nephropathy with different renal function and different urinary protein levels complicated with diabetes,so as to provide theoretical basis for the diagnosis and treatment of IMN complicated with diabetes.Methods:278 patients diagnosed with biopsy-proven IMN were studied in The First Hospital of Jilin University from August 2018 to February 2022.278 IMN patients were divided into diabetic group(n = 53)and non-diabetic group(n = 225)according to whether they had diabetes mellitus,then according to the Estimated glomerular filtration rate(e GFR)level at the time of renal biopsy,IMN patients in the diabetic group were divided into group A(e GFR ≥90ml/min/1.73 ㎡,n=32)and group B(e GFR<90ml/min/1.73 ㎡,n=21);IMN patients in the non-diabetic group were divided into group C(e GFR≥90ml/min/1.73 ㎡,n=173)and group D(e GFR<90ml/min/1.73㎡,n=52).According to the 24 h urine total protein(UTP)level,IMN patients in the diabetic group were divided into group E(UTP<3.5g/d,n=13)and group F(UTP≥3.5g/d,n=40);IMN patients in the non-diabetic group were divided into group G(UTP< 3.5g/d,n=70)and group H(UTP≥3.5g/d,n=155).The clinical data,laboratory indexes and pathology of IMN patients with different renal function and different urinary protein levels were compared between the diabetic group and non-diabetic group.SPSS 26.0 software was used to analyze the above statistical data.Results:1.Among IMN patients with normal renal function,compared with non-diabetic group(group C),patients in diabetic group(group A)were older and had higher systolic blood pressure(P<0.05),and there was no difference in the incidence of thrombosis and infection between the two groups(P>0.05).In terms of laboratory indexes,globulin and fibrinogen were higher in the diabetic group(P<0.05).In terms of pathology,the proportion of glomerular sclerosis,renal tubule atrophy,interstitial fibrosis and renal arteriole lesions were higher in the diabetic group under light microscope(P<0.05),and there was no difference in renal interstitial inflammatory cell infiltration between the two groups(P>0.05).The pathological stages of the two groups were mainly stage Ⅰand stage Ⅱ,and immunofluorescence showed that immunoglobulin Ig G and complement C3 were mainly deposited,accompanied by more complement C4 deposition,in addition,the diabetic group was accompanied by more complement C1 q deposition,and the diabetic group had a lower C3 deposition rate and a higher C1 q deposition rate(P<0.05).2.Among IMN patients with renal insufficiency,compared with non-diabetic group(group D),patients in the diabetic group(group B)had higher body mass index(P<0.05),and there was no difference in the incidence of thrombosis and infection between the two groups(P>0.05).There were no significant differences in serum albumin,serum creatinine,serum uric acid,blood lipid,hemoglobin,urinary protein and other laboratory indexes between the two groups(P>0.05).In terms of pathology,the incidence of renal tubule atrophy,interstitial inflammatory cell infiltration and interstitial fibrosis were higher in the diabetic group under light microscope(P<0.05),and there was no difference in the proportion of glomerular sclerosis and the incidence of renal arteriolar lesions between the two groups(P>0.05).The pathological stages of the two groups were mainly stage Ⅰ and stage Ⅱ,and immunofluorescence showed that immunoglobulin Ig G and complement C3 were mainly deposited,accompanied by more complement C4 deposition,and there was no statistical significance in immune deposits(P>0.05).3.Among IMN patients with nephrotic range proteinuria,compared with nondiabetic group(group H),patients in the diabetic group(group F)had higher body mass index(P<0.05),and there was no difference in the incidence of thrombosis and infection between the two groups(P>0.05).In terms of laboratory indexes,globulin,fibrinogen and urinary microalbumin were higher in the diabetic group(P<0.05).In terms of pathology,the proportion of glomerular sclerosis,renal tubule atrophy,interstitial fibrosis and renal arteriole lesions were higher in the diabetic group under light microscope(P<0.05),and there was no difference in renal interstitial inflammatory cell infiltration between the two groups(P>0.05).The pathological stages of the two groups were mainly stage Ⅰ and stage Ⅱ,and immunofluorescence showed that immunoglobulin Ig G and complement C3 were mainly deposited,accompanied by more complement C4 deposition,and there was no statistical significance in immune deposits(P>0.05).4.Among IMN patients with non-nephrotic range proteinuria,compared with nondiabetic group(group G),patients in the diabetic group(group E)were older and had higher systolic blood pressure(P<0.05),and there was no difference in the incidence of thrombosis and infection between the two groups(P>0.05).There were no significant differences in serum albumin,serum creatinine,serum uric acid,blood lipid,hemoglobin,urinary protein and other laboratory indexes between the two groups(P >0.05).In terms of pathology,the incidence of renal tubule atrophy and interstitial fibrosis were higher in the diabetic group under light microscope(P<0.05),and there were no differences in the proportion of glomerular sclerosis,interstitial inflammatory cell infiltration and renal arteriolar lesions between the two groups(P>0.05).The pathological stages of the two groups were mainly stage Ⅰ and stage Ⅱ,and immunofluorescence showed that immunoglobulin Ig G and complement C3 were mainly deposited,accompanied by more complement C4 deposition,and there was no statistical significance in immune deposits(P>0.05).Conclusions:1.Among all IMN patients included,the pathological stages were mainly stage Ⅰand stage Ⅱ,and the immunofluorescence showed that immunoglobulin Ig G and complement C3 were mainly deposited,accompanied by more complement C4 deposition.The renal tubule atrophy and interstitial fibrosis were more obvious in the diabetic group.2.Among IMN patients with normal renal function,patients in the diabetic group were older and had higher systolic blood pressure.The levels of globulin and fibrinogen in the diabetic group were higher.In the diabetic group,glomerular and renal arteriole lesions were more obvious,the rate of C3 deposition was lower,and the rate of C1 q deposition was higher.Among IMN patients with renal insufficiency,the body mass index was higher in the diabetic group,and the renal interstitial inflammatory cell infiltration was more obvious.3.Among IMN patients with nephrotic range proteinuria,patients in the diabetic group had higher body mass index.The levels of globulin,fibrinogen and urinary microalbumin in the diabetic group were higher.In the diabetic group,glomerular and renal arteriole lesions were more obvious.Among IMN patients with non-nephrotic range proteinuria,the diabetic group was older and had higher systolic blood pressure. |
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