Abstract
BackgroundIdiopathic membranous nephropathy (IMN) is frequently coexisted with diabetes mellitus (DM). Few researches investigate clinical outcomes in IMN patients coexisting diabetes mellitus (DM), including remission rates, renal survival and complications. Concurrent DM also pose therapeutic challenges to IMN patients due to the influence of glucocorticoids and immunosuppressant on metabolic disorders. We performed this study to investigate the impact of DM on clinical outcomes in IMN and the influence of therapeutic regime on metabolic parameters in diabetic IMN patients.MethodsTwo hundred and six adult hospitalized patients diagnosed with biopsy-proven IMN were retrospectively studied, including 42 patients coexisted with DM. Clinical outcomes including remission rates, renal outcome and complications were compared between groups. Impact of cyclophosphamide and ciclosporin on metabolism and complications were analyzed in IMN patients coexisting DM.ResultsIMN patients coexisted with DM were presented with advanced age, lower level of eGFR and hemoglobin. Patients coexisted with DM experienced worse renal function deterioration and higher incidence of infection. COX regression analysis showed that DM was an independent risk factor for renal function deterioration in IMN patients. There was no significant difference in remission rates and incidence of venous thromboembolism between two groups. Further exploration on the impact of therapeutic regimens on complications and metabolism showed that cyclophosphamide and ciclosporin had no significant difference in incidence of complications including infection and venous thromboembolism, and posed comparable influences on blood glucose, uric acid and blood lipids in IMN patients coexisted with DM.ConclusionCoexisting DM was an independent risk factor for renal function deterioration in IMN patients but did not influence the remission of proteinuria. Glucocorticoids in combination with cyclophosphamide or ciclosporine had similar impact on complications and metabolic index including blood glucose, uric acid and blood lipids in IMN patients coexisted with DM.
Highlights
Idiopathic membranous nephropathy (IMN) is frequently coexisted with diabetes mellitus (DM)
Glucocorticoids in combination with cyclophosphamide or ciclosporine had similar impact on complications and metabolic index including blood glucose, uric acid and blood lipids in IMN patients coexisted with DM
We performed this retrospective observational study to explore clinical outcomes in IMN patients coexisted with DM and analyze the influence of cyclophosphamide and ciclosporin on metabolic parameters in diabetic IMN patients
Summary
Study participants Three hundred and twenty-nine patients with biopsyproven membranous nephropathy (MN) were included in this study in Guangdong Provincial People’s Hospital from September 2015 to November 2017. Since June 1st 2017 in our center and 47 consecutive IMN patients were available for detection of glomerular THSD7A antigen staining in this retrospective observational study. The end-point of renal function deterioration was defined as a decrease in the eGFR to 30% of the baseline level or progression to endstage renal disease (ESRD) during the follow-up [15]. The measurement data accorded with normal distribution were expressed as the mean ± SD and differences between two groups were compared using the t tests. Kaplan-Meier survival analysis was performed to compare remission rates and renal function outcomes between two groups, and log-rank test was used to evaluate significance of differences. Differences were considered to be statistically significant when the P value was less than 0.05
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