Qin Ai-Bo, Yu Xiao-Juan, Wang Su-Xia, Zhou Fu-de, Zhao Ming-Hui
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Kidney Dis (Basel). 2021 Mar;7(2):156-165. doi: 10.1159/000510877. Epub 2020 Sep 29.
Long-term exposure to mercury can cause minimal change disease. However, the current understanding of mercury-associated minimal change disease (M-MCD) is inadequate. To improve the understanding of M-MCD, this study retrospectively analyzed the clinicopathological, ultrastructural, and prognostic features of M-MCD, in comparison with primary minimal change disease (P-MCD).
We retrospectively analyzed the clinicopathological data of 21 M-MCD patients and 21 P-MCD patients. Electron micrographs of glomerular capillaries were taken, and the foot process width (FPW) was measured. A receiver operating characteristics (ROC) curve analysis was performed to determine the optimum cutoff value of FPW that can differentiate the M-MCD from P-MCD.
M-MCD patients presented similar clinical and routine pathological characteristics with P-MCD patients but had lower levels of FPW (935.0 [interquartile range (IQR) 853.7-1,176.7] nm vs. 1,403.2 [IQR 1,089.2-1,841.8] nm, = 0.002). ROC curve analysis showed that FPW value below 1,385 nm might help to differentiate M-MCD from P-MCD (area under the curve of 0.787, sensitivity of 94.7%, and specificity of 52.4%). For patients with M-MCD, 77.8% achieved complete remission after mercury detoxification monotherapy. Patients with M-MCD had a lower relapse rate than patients with P-MCD (0 vs. 47.1%, = 0.003). In addition, there was no significant difference in remission time between M-MCD patients treated with mercury detoxification monotherapy and those initially treated with immunosuppressive therapy (2.0 [IQR 1.0-6.0] months vs. 2.0 [IQR 1.5-2.5] months, = 0.606).
M-MCD patients showed similar clinicopathological features with P-MCD patients, but with less severe foot process effacement, suggesting different pathogenesis of these 2 disease entities. The treatment of mercury detoxification was highly effective for patients with M-MCD and can be considered as a primary choice in clinical practice.
长期接触汞可导致微小病变性肾病。然而，目前对汞相关微小病变性肾病（M-MCD）的认识尚不足。为提高对M-MCD的认识，本研究回顾性分析了M-MCD与原发性微小病变性肾病（P-MCD）的临床病理、超微结构及预后特征。
我们回顾性分析了21例M-MCD患者和21例P-MCD患者的临床病理数据。拍摄肾小球毛细血管的电子显微镜照片，并测量足突宽度（FPW）。进行受试者工作特征（ROC）曲线分析，以确定可区分M-MCD与P-MCD的FPW最佳截断值。
M-MCD患者的临床和常规病理特征与P-MCD患者相似，但FPW水平较低（935.0[四分位间距（IQR）853.7 - 1,176.7]nm对1,403.2[IQR 1,089.2 - 1,841.8]nm，P = 0.002）。ROC曲线分析显示，FPW值低于1,385nm可能有助于区分M-MCD与P-MCD（曲线下面积为0.787，敏感性为94.7%，特异性为52.4%）。对于M-MCD患者，77.8%在单纯驱汞治疗后实现完全缓解。M-MCD患者的复发率低于P-MCD患者（0对47.1%，P = 0.003）。此外，单纯驱汞治疗的M-MCD患者与最初接受免疫抑制治疗的患者在缓解时间上无显著差异（2.0[IQR 1.0 - 6.0]个月对2.0[IQR 1.5 - 2.5]个月，P = 0.606）。
M-MCD患者的临床病理特征与P-MCD患者相似，但足突消失程度较轻，提示这两种疾病实体的发病机制不同。驱汞治疗对M-MCD患者疗效显著，可作为临床实践的首选治疗方法。
