Department of Nephrology, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Shantou University, Shantou, China,
Nephron. 2024;148(2):95-103. doi: 10.1159/000533414. Epub 2023 Aug 23.
Primary membranous nephropathy (PMN) is the most common pathological type of nephrotic syndrome in adults. Intrarenal small artery intimal thickening can be observed in most renal biopsies. The purpose of this study was to investigate the association between intrarenal small artery intimal thickening and clinicopathological features and prognosis in PMN patients.
Data were continuously collected from patients who were diagnosed with PMN in Shenzhen Second People's Hospital (The First Affiliated Hospital of Shenzhen University) from 2008 to 2021 for a retrospective cohort study. Regression analysis and survival analysis were used to analyze the relationship between intrarenal small artery intimal thickening and renal prognosis in PMN patients.
300 PMN patients were enrolled in this study, including 165 patients (55%) with intrarenal small artery intimal thickening. Patients with intimal thickening were older, with higher BMI, systolic blood pressure and diastolic blood pressure, serum uric acid, a higher proportion of hypertension, acute kidney injury, nephrotic syndrome, more urine protein, and lower eGFR. Multivariate Cox regression analysis showed that after adjusting for age, gender, hypertension, BMI, urine protein, eGFR, and the use of ACEI/ARB and hormone immunosuppressants, intimal thickening was a risk factor for renal prognosis in PMN patients (HR = 3.68, 95% CI 1.36-9.96, p < 0.05). Kaplan-Meier survival curve analysis showed that the incidence of reaching the renal composite outcome was higher in the intimal thickening group (p < 0.05).
The prognosis of PMN patients with intrarenal small artery intimal thickening is worse, so early intervention is very important for these patients.
原发性膜性肾病（PMN）是成人肾病综合征中最常见的病理类型。大多数肾活检中可观察到肾内小动脉内膜增厚。本研究旨在探讨PMN 患者肾内小动脉内膜增厚与临床病理特征和预后的关系。
对 2008 年至 2021 年在深圳第二人民医院（深圳大学第一附属医院）诊断为 PMN 的患者进行连续数据采集，进行回顾性队列研究。回归分析和生存分析用于分析 PMN 患者肾内小动脉内膜增厚与肾脏预后的关系。
本研究共纳入 300 例 PMN 患者，其中 165 例（55%）患者存在肾内小动脉内膜增厚。内膜增厚患者年龄较大，BMI、收缩压和舒张压、血尿酸较高，高血压、急性肾损伤、肾病综合征的比例较高，尿蛋白较多，eGFR 较低。多变量 Cox 回归分析表明，在校正年龄、性别、高血压、BMI、尿蛋白、eGFR 以及 ACEI/ARB 和激素免疫抑制剂的使用后，内膜增厚是 PMN 患者肾脏预后的危险因素（HR=3.68，95%CI 1.36-9.96，p＜0.05）。Kaplan-Meier 生存曲线分析显示，内膜增厚组达到肾脏复合终点的发生率较高（p＜0.05）。
PMN 患者肾内小动脉内膜增厚的预后较差，因此对这些患者进行早期干预非常重要。
