| Objectives:To analyze the clinical and pathological data of adult patients diagnosed with Idiopathic and membranous nephropathy(IMN)in a single center in northern China,so as to improve clinicians’ understanding of the diagnosis,treatment and prognosis of IMN.Methods:A single-center retrospective analysis was conducted on the clinical,pathological and prognostic data of 232 IMN patients admitted to the Department of Nephrology,the First Hospital of Jilin University from January 2020 to February 2022.All patients underwent renal puncture biopsy and had complete case data records.Clinical data included gender,age,history of hypertension and diabetes,blood urea nitrogen(BUN),uric acid(UA),serum creatinine(Scr),serum albumin(ALB),total cholesterol(TCHO),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglycerides(TG),urinary red blood cells/HPF(URBC),24 hours urinary protein(24h-UTP),24 hours urinary microalbumin(24h-MALB),urinary α1-microglobulin(α1-MG),urinary Ig G,urinary β2-microglobulin(β2-MG),serum Ig G,serum Ig A,serum Ig M,complement 3(C3),complement4(C4),erythrocyte sedimentation(ESR),hemoglobin(HB),estimated glomerular filtration rate(e GFR),serum anti-phospholipase A2 receptor(PLA2R)antibody.Pathological data included whether renal tissue had glomerulosclerosis,mesangial cell and mesangial matrix hyperplasia,spike process formation,crescent body formation,renal interstitial damage and renal vascular disease,as well as immunoglobulin and complement deposition in renal tissue,including Ig A,Ig M,Ig G,C3,C4,C1 q,Fib,Kappa and Lambda.All patients were divided into two groups(male group and female group)according to gender.They were divided into 3groups according to age(youth group,middle-aged group and old group);The patients were divided into 2 groups according to the positive and negative anti-PLA2 R antibodies(PLA2R antibody positive group,PLA2 R antibody negative group),and 2 groups according to whether there was C1 q deposition in kidney tissue(C1q negative group,C1 q positive group).The clinicopathologic data were discussed and studied respectively,and SPSS 26.0 software was used for statistical analysis.Results:1.Among the 232 selected IMN patients,143 were males and 89 were females,with a male to female ratio of 1.6:1.The onset age ranged from 21 to 73 years,with a median age of53 years,including 56 elderly patients(age ≥60 years),115 middle-aged patients(45 years≤ age < 60 years),and 61 young patients(18 years ≤ age < 45 years).104 cases had hypertension,accounting for 44.8%,and 21 cases had diabetes,accounting for 9.1%.2.Grouped by gender,Urinary secretion in male was significantly higher than that in female in BUN,Scr,UA,24h-UTP,24h-MALB,α1-MG,Urinary Ig G,CRP,HGB,renal interstistial damage rate.ALB、HDL-C、Serum Ig G,Serum Ig M,ESR and e GFR were significantly lower than those of females,with statistical significance(P < 0.05).There was no significant difference in clinical remission rate between male and female patients after 6and 12 months of follow-up(P > 0.05).3.According to age group,among the 232 patients,61 cases(26.3%)were in the young group,115 cases(49.6%)were in the middle age group,and 56 cases(24.1%)were in the old group.With the increase of age,BUN and Serum Ig A increased,while e GFR decreased obviously.The incidence of hypertension,glomerulosclerosis and renal vascular disease was linearly correlated with age.With the increase of age,the incidence of hypertension,glomerulosclerosis and renal vascular disease was higher.There were significant differences in renal Kappa and Lambda deposition in young,middle-aged and elderly groups(P < 0.05),and the deposition rates of Kappa and Lambda in young IMN patients were significantly lower than those in middle-aged and elderly patients.There was no significant difference in the clinical remission rate of IMN patients in the young,middle and old groups at 6 and 12 months after treatment(P > 0.05).4.According to the anti-PLA2 R antibody levels,the anti-Pla2 R antibody levels were divided into negative group and positive group,including 165 positive cases(71.1%)and 58 negative cases(25.0%).The male proportion,hypertension rate,Scr,BUN,TCHO,HDL-C,URBC,24h-UTP,24h-MALB,α1-MG,urinary Ig G,nail process formation and interstitial damage rate,and the intensity of renal complement C3 deposit in positive group were higher than those in negative group.The deposition intensity of ALB,serum Ig G,serum Ig A,serum Ig M and renal Ig M was lower than that of negative group,and the difference was statistically significant(P < 0.05).There was no significant difference in clinical remission rate between2 groups after 6 and 12 months of follow-up(P > 0.05).5.According to whether there was C1 q deposition in renal tissue,there were 186 cases(80.2%)in the positive group and 46 cases(19.8%)in the negative group.The deposition intensity of kidney Ig A,kidney Ig M,and kidney complement C3 and C4 in C1 q positive group was higher than that in C1 q negative group,while the concentration of blood complement C4 was lower than that in negative group,the difference was statistically significant(P < 0.05).There was no significant difference in clinical remission rate between 2 groups after 6 and 12 months of follow-up(P > 0.05).6.Logistic regression analysis showed that the formation of nail process in punctured glomeruli was a risk factor for the prognosis of IMN patients(P < 0.05).Conclusions:1.The single center statistics in north China show that the majority of adult IMNs are middle-aged and elderly males.2.In male IMN patients,Scr,24h-UTP and other indicators reflecting renal function decline were significantly higher than that of female patients.BUN,glomerulosclerosis rate and other indicators reflecting renal function impairment increased with the increase of age.3.The proportion of male and hypertensive patients in anti-PLA2 R antibody positive IMN patients was higher than that in negative group.The deposition of Ig A,Ig M,C3 and C4 in kidney tissue of C1 q positive group was higher than that of C1 q negative group.It is suggested that the kidney injury of IMN patients with positive anti-PLA2 R antibody and positive C1 q deposition is more serious.4.The 6-month and 12-month follow-up results suggested that there was no significant difference in the short-term clinical response rate of IMN patients with different genders,ages,positive anti-PLA2 R antibodies and C1 q deposition in renal tissue,which may be related to the single-center study,small sample size or short follow-up time.5.The formation of nail process in the renal puncture tissue may be a risk factor for the prognosis of IMN patients. |
