Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Renal Division, University of Freiburg Medical Center, Freiburg, 79106, Germany.
Curr Med Sci. 2022 Oct;42(5):1007-1014. doi: 10.1007/s11596-022-2628-y. Epub 2022 Sep 30.
To assess the significance of focal segmental glomerulosclerosis (FSGS) variants on clinicopathological characteristics and short-term outcomes in idiopathic membranous nephropathy (IMN) patients.
The clinicopathological data of 146 IMN patients diagnosed between December 2016 and March 2019 in our center were collected and analyzed. These patients were divided into the pure IMN group, IMN with glomerular tip lesion (GTL) group, and IMN with non-GTL FSGS group.
The IMN with non-GTL FSGS and IMN with GTL groups both had higher proportions of patients with hypertension, lower serum albumin, and severe proteinuria, while the IMN with non-GTL FSGS group additionally showed higher blood pressure and serum cholesterol, and lower serum IgG than the IMN group (all P<0.05). As for pathology, the IMN with non-GTL FSGS group had higher proportions of patients with acute tubular injury and moderate to severe chronic injuries than the IMN group (all P<0.05). In the IMN, IMN with GTL, and IMN with non-GTL FSGS groups, the overall one-year remission rates were 81.6%, 76%, and 58.8%, respectively. Furthermore, the IMN with non-GTL FSGS group showed the lowest cumulative incidence to reach remission within one year. Multivariate Cox logistic analysis demonstrated that higher level of serum anti-M-type phospholipase A2 receptor antibody and the existence of non-GTL FSGS lesion were independent predictors for no remission in IMN patients.
The non-GTL FSGS lesion was a novel negative predictor in IMN and should be taken into account in the management of IMN.
评估局灶节段性肾小球硬化（FSGS）变异在特发性膜性肾病（IMN）患者临床病理特征和短期结局中的意义。
收集并分析了 2016 年 12 月至 2019 年 3 月在本中心诊断的 146 例 IMN 患者的临床病理数据。将这些患者分为单纯 IMN 组、IMN 合并肾小球顶病变（GTL）组和 IMN 合并非 GTL FSGS 组。
IMN 合并非 GTL FSGS 组和 IMN 合并 GTL 组的高血压患者比例较高，血清白蛋白较低，蛋白尿较重，而 IMN 合并非 GTL FSGS 组的血压和血清胆固醇较高，血清 IgG 较低（均 P<0.05）。在病理方面，IMN 合并非 GTL FSGS 组急性肾小管损伤和中重度慢性损伤患者比例高于 IMN 组（均 P<0.05）。在 IMN、IMN 合并 GTL 和 IMN 合并非 GTL FSGS 组中，总体一年缓解率分别为 81.6%、76%和 58.8%。此外，IMN 合并非 GTL FSGS 组在一年内达到缓解的累积发生率最低。多因素 Cox 逻辑回归分析表明，血清抗 M 型磷脂酶 A2 受体抗体水平较高和存在非 GTL FSGS 病变是 IMN 患者无缓解的独立预测因素。
非 GTL FSGS 病变是 IMN 的一个新的阴性预测因子，在 IMN 的管理中应予以考虑。
