Li Shang-Mei, Yang La-Wei, Huang Zhi-Qing, Ma Jia-Ying, Wu Jiao-Hua, Liu Hua-Feng, Xu Yong-Zhi, Luo Mian-Na
Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, 524001, People's Republic of China.
Guangdong Provincial Key Laboratory of Autophagy and Major Chronic Non-Communicable Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, 524001, People's Republic of China.
J Inflamm Res. 2024 Dec 10;17:10871-10885. doi: 10.2147/JIR.S497939. eCollection 2024.
The role of crescent formation in primary membranous nephropathy (PMN) and its potential impact on prognosis remain an area of ongoing investigation. This study stratifies patients with PMN into two cohorts: one with crescents and one without. It then compares these groups to investigate the influence of crescents on the prognosis of PMN.
In this retrospective analysis, we included patients who had a confirmed diagnosis of PMN and exhibited crescents upon renal biopsy. The study population was sourced from the medical records at the Affiliated Hospital of Guangdong Medical University in Zhanjiang, China, spanning from January 2017 to June 2023. To enable a comparative analysis of clinical, pathological, and prognostic features, a control group was established, comprising 106 patients diagnosed with PMN who did not have crescent formation. These controls were randomly selected from the same time frame. Regular follow-up of the patients continued in the outpatient setting for at least six months.
A total of 53 patients with PMN and crescent formation were included in this study, while 106 individuals without crescents served as a randomly selected control group. Patients with PMN and crescents exhibited higher systolic blood pressure ( = 0.015), 24-hour proteinuria ( = 0.006), serum creatinine ( = 0.029) levels, and lower glomerular filtration rate ( = 0.002), compared to those without crescents. Histological examination revealed a higher proportion of focal segmental sclerosis ( < 0.001), spherical sclerosis ( < 0.001), arteriosclerosis ( = 0.02), and interstitial fibrosis with tubular necrosis ( = 0.002) in patients with PMN and crescent formation. Immunofluorescence staining demonstrated a weaker IgG4 fluorescence intensity in patients with PMN and crescent formation. At the end of the follow-up period, patients with PMN and crescents had a lower remission rate ( = 0.022), poorer renal function ( = 0.007), and lower albumin ( = 0.039) levels. Kaplan-Meier (KM) analysis identified proteinuria and crescent formation as independent risk factors for adverse outcomes in patients with PMN ( < 0.001 and < 0.05). Immunohistochemistry staining revealed positive expression of CD68 and CD20 in the renal interstitium of patients with PMN, regardless of the presence of crescents.
Crescent formation is associated with a risk of adverse outcomes in patients with PMN. Patients with crescents exhibit severe clinical and pathological features and have poorer prognoses.
新月体形成在原发性膜性肾病（PMN）中的作用及其对预后的潜在影响仍是一个正在研究的领域。本研究将PMN患者分为两个队列：一个有新月体，一个没有。然后比较这两组以研究新月体对PMN预后的影响。
在这项回顾性分析中，我们纳入了确诊为PMN且肾活检显示有新月体的患者。研究人群来自中国湛江广东医科大学附属医院2017年1月至2023年6月的病历。为了对临床、病理和预后特征进行比较分析，设立了一个对照组，包括106例诊断为PMN但没有新月体形成的患者。这些对照是在同一时间段内随机选择的。患者在门诊进行定期随访至少六个月。
本研究共纳入53例有新月体形成的PMN患者，106例无新月体的患者作为随机选择的对照组。与无新月体的患者相比，有新月体的PMN患者收缩压更高（P = 0.015）、24小时蛋白尿更高（P = 0.006）、血清肌酐更高（P = 0.029），肾小球滤过率更低（P = 0.002）。组织学检查显示，有新月体形成的PMN患者局灶节段性硬化比例更高（P < 0.001）、球性硬化比例更高（P < 0.001）、动脉硬化比例更高（P = 0.02）以及间质纤维化伴肾小管坏死比例更高（P = 0.002）。免疫荧光染色显示，有新月体形成的PMN患者IgG4荧光强度较弱。在随访期末，有新月体的PMN患者缓解率更低（P = 0.022）、肾功能更差（P = 0.007）、白蛋白水平更低（P = 0.039）。Kaplan - Meier（KM）分析确定蛋白尿和新月体形成是PMN患者不良结局的独立危险因素（P < 0.001和P < 0.05）。免疫组织化学染色显示，无论有无新月体，PMN患者肾间质中CD68和CD20均呈阳性表达。
新月体形成与PMN患者不良结局风险相关。有新月体的患者表现出严重的临床和病理特征，预后较差。
