Kitajima Shinji, Furuichi Kengo, Sakai Norihiko, Sagara Akihiro, Shinozaki Yasuyuki, Toyama Tadashi, Iwata Yasunori, Shimizu Miho, Yokoyama Hitoshi, Kaneko Shuichi, Wada Takashi
Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.
Clin Exp Nephrol. 2015 Apr;19(2):278-83. doi: 10.1007/s10157-014-0987-9. Epub 2014 Jun 24.
The prognosis in patients with idiopathic membranous nephropathy (IMN) is diverse. However, the prognosis after relapse and factors affecting relapse remain unclear.
A total of 146 Japanese patients with IMN who had been followed up for at least 3 years, or until end-stage renal failure or death were enrolled in this retrospective study. The initial clinicopathological factors were examined between the patients with and without relapse. The patients were assigned to two groups based on the electron microscopic findings: homogeneous type with synchronous electron-dense deposits and heterogeneous type with various phases of dense deposits.
A total of 105 of the 146 patients (72 %) achieved complete remission (CR) or incomplete remission (ICR) I after initial treatment. Twenty-six of the 105 patients relapsed after CR or ICR I (25 %). There were no differences in initial clinical findings or data between the patients with and without relapse, except for the higher degree of proteinuria at onset in patients with relapse. The relapse rate of the heterogeneous group (43 %) was higher than that in the homogeneous group (20 %). There were no significant associations between relapse rate and immunosuppressive therapy at onset. Eleven of 26 patients showing relapse (42 %) achieved CR or ICR I, which was lower than the rate for patients with initial remission.
Our results suggest that patients with relapse achieved CR or ICR I and that electron microscopic findings demonstrating heterogeneous type indicated susceptibility to relapse.
特发性膜性肾病（IMN）患者的预后各不相同。然而，复发后的预后以及影响复发的因素仍不明确。
本回顾性研究纳入了146例日本IMN患者，这些患者至少随访了3年，或直至终末期肾衰竭或死亡。对复发患者和未复发患者的初始临床病理因素进行了检查。根据电子显微镜检查结果将患者分为两组：具有同步电子致密沉积物的均质型和具有不同阶段致密沉积物的异质型。
146例患者中有105例（72%）在初始治疗后达到完全缓解（CR）或不完全缓解（ICR）I。105例患者中有26例在CR或ICR I后复发（25%）。复发患者和未复发患者的初始临床表现或数据无差异，只是复发患者起病时蛋白尿程度更高。异质组的复发率（43%）高于均质组（20%）。复发率与起始免疫抑制治疗之间无显著相关性。26例复发患者中有11例（42%）达到CR或ICR I，低于初始缓解患者的比例。
我们的结果表明，复发患者可达到CR或ICR I，并且电子显微镜检查结果显示为异质型表明易复发。
