Abstract
BackgroundThe goal of this study was to investigate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesions.MethodsIn our hospital, 305 patients with nephrotic syndrome confirmed as IMN by renal biopsy were divided into a non-focal segmental lesion group (FSGS- group) and a focal segmental glomerulosclerosis (FSGS) group (FSGS+ group) and retrospectively analyzed. In all, 180 patients were followed for periods ranging from 6 months to 2 years. The general clinicopathological data of both groups were compared, and the effects of different treatment schemes on the prognosis of both groups were observed.ResultsThe FSGS+ group had a longer disease course, higher blood pressure levels, and higher serum creatinine and β2-microglobulin levels than did the FSGS- group (all P < 0.05). Pathologically, the FSGS+ group had increased glomerular sclerosis, glomerular mesangial hyperplasia, and acute and chronic tubular lesion rates (all P < 0.05). The remission rate was lower in the FSGS+ group than in the FSGS- group (64.7% vs 82.2%) and, among patients in the FSGS+ group, was lower in patients treated with calmodulin inhibitors than in those treated with cyclophosphamide (P < 0.01). Survival analysis showed that the FSGS+ group had a poor prognosis (χ2 = 4.377, P = 0.036), and risk factor analysis suggested that age at renal biopsy (P = 0.006), 24-h urinary protein quantity (P = 0.01), chronic tubulointerstitial lesions (P = 0.055), and FSGS lesions (P = 0.062) were risk factors for worsening renal condition; furthermore, 24-h urinary protein quantity was an independent risk factor for worsening renal condition.ConclusionsMembranous nephropathy with FSGS is a risk factor, but not an independent risk factor, for IMN. Patients with membranous nephropathy with FSGS often present hypertension and tubule injury. The nonselective drug cyclophosphamide is preferred, and calcineurin inhibitors should be used with caution.
Highlights
The goal of this study was to investigate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesions
Previous studies have shown that sex, age, blood pressure, estimated glomerular filtration rate, serum creatinine proteinuria, and urinary red blood cell count are prognostic factors, while other studies have shown that anti-phospholipase A2 receptor antibody is an important biochemical indicator to help predict prognosis and guide treatment [5,6,7,8,9,10]
We found that approximately one-fifth of patients with membranous nephropathy complicated with focal segmental glomerulosclerosis (FSGS) lesions (IMN-FSGS) were found during renal biopsy
Summary
The goal of this study was to investigate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesions. Nephrological changes, especially membranous nephropathy with focal segmental glomerulosclerosis (FSGS), cannot be ignored as a prognostic index in patients with IMN. Recent research conclusions are not obvious; Chen Y et al suggested that segmental sclerosis and tubulointerstitial injury rather than arteriosclerosis or C3 deposition are independent risk factors for ESRD in patients with membranous nephropathy [11]. The different views of these people suggest that the predictive effect of FSGS and other factors on the prognosis of membranous nephropathy is controversial and needs to be further studied
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