A mono-center clinical study on clinical pathological features and prognosis of adult idiopathic membranous nephropathy

Objective To analyze clinical pathological features and prognosis-related factors in patients with adult idiopathic membranous nephropathy (IMN), in order to provide new ideas for clinical diagnosis. Methods Retrospective analysis was performed on the clinical and pathological data of 83 patients diagnosed with IMN by renal puncture biopsy in the department of nephrology, the Second Hospital Affiliated to Kunming Medical University from January 2015 to December 2017, and eGFR<30 mL·min^-1·(1.73 m²)^-1 was used as the end point of follow-up to analyze the follow-up data of the patients. Results Among the 83 IMN patients, 55 ones (66.26%) were males and 28 ones (33.73%) were females,and the ones with an age ≥ 30 accounted for 91.57%, with an average age of 50.9±12.7. For pathological types, stage Ⅰ and Ⅱ period were predominant, accounting for 83.13%. Compared with the female patients, the male ones had older ages, higher levels of serum creatinine and 24 -hour urinary protein, more severe renal tubular interstitial damage, and lower glomerular filtration rate and serum albumin (P<0.05). Compared to the non-senile patients, the senile ones had increased male proportion and 24-hour urinary protein, notably reduced renal function, and aggravated renal tubulointerstitium damage (P<0.05). IMN patients clinical manifestation there was no statistically significant difference between IMN patients at different pathological stages (P>0.05). After the follow-up of 12~24 months, 12 patients progressed to show eGFR<30 mL·min^-1·(1.73 m²)^-1. The differences between the patients with progressed real damage and those with stable renal functions were of statistical significance in average artery pressure, and other clinical manifestations of nephrotic syndrome proportion, eGFR, 24 hours urinary protein and renal tubulointerstitium damage (P<0.05). Conclusions Those senile male patients with hypertension and higher urinary protein level are prone to experience decreased renal functions and aggravated renal tubular interstitial damage, and the IMN patients with the above factors may have poor prognosis. Therefore, the patients should be diagnosed definitely and intervened medically in an individualized manner.