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The clinicopathological and prognostic features of young patients with membranous nephropathy
2017, 16 (04):
242-246.
doi: 10.3969/j.issn.1671-4091.2017.04.007
Objective To investigate the clinicopathological and prognostic features of young patients with membranous nephropathy (MN). Methods The clinical data of 52 young patients (15-30 years old) diagnosed as MN and nephrotic syndrome and admitted to Peking University Third Hospital from 2000 to 2016 were retrospectively analyzed. Comparison was made between these patients and the 53 patients of 40～60 years old diagnosed as MN and nephrotic syndrome during the same period in the hospital. Clinicopathological and prognostic features of the two groups of patients were analyzed. Results ①Clinically, there were no differences in 24 hour urinary protein and serum albumin (9.7±4.8g vs. 9.4±4.6g, t=0.294, P=0.770 for urinary protein; 24.5±5.7g/L vs. 24.4±3.6g/L, t=0.100, P=0.921 for serum albumin) between the two groups. However, young MN patients had lower proportion of hypertension (1.9% vs. 37.7%, χ2=21.040, P＜0.001), lower proportion of microscopical hematuria (44.2% vs. 67.9%, χ2=5.986, P=0.014), lower serum creatinine (64.9±20.4μmol/L vs. 77.0 ± 31.7μmol/L, t=- 2.311, P=0.023), higher estimated glomerular filtration rate (eGFR) (150.7±44.4ml/min vs. 104.6±31.0ml/min, t=6.145, P＜0.001) and shorter disease course [4.0(2.0, 12.0)w vs. 12.0(4.0, 32.0)w, Z=-3.184, P=0.001]. ②Pathologically, more atypical MN features were present in young patients (51.9% vs. 9.4%, χ2=26.785, P＜0.001), and stage II was the main pathological change in older patients. Higher positive ratios of IgA (32.7% vs. 11.3%, χ2=7.008, P=0.008) and IgM (51.9% vs. 24.5%, χ2=8.353, P= 0.004), less renal tubulointerstitial lesions [0.0(0.0, 1.0) vs. 1.0(0.0, 2.0), Z=-4.102, P＜0.001] and less arterial wall thickening [0.0(0.0, 1.0) vs. 1.0(1.0, 1.0), Z=-3.984, P＜0.001] were the characteristics of young patients. ③ Therapeutically, 48.1% young patients received corticosteroid monotherapy, and 51.9% young patients received corticosteroids plus immunosuppressants. In the older group, all patients received corticosteroids plus immunosuppressants. In the young group, there were no differences in partial remission rate, complete remission rate, recurrent rate, partial remission time and complete remission time (28.0% vs. 18.2%, χ2=0.629, P=0.428; 36.0% vs. 63.6%, χ2=3.577, P=0.059; 7.7% vs. 18.5%, χ2=3.225, P=0.199; 2.5±1.5m vs. 3.0±1.5m, t=-1.094, P=0.281; 5.0±2.8m vs. 7.4±2.0m, t=-1.818, P=0.087) between the patients with corticosteroid monotherapy and those with corticosteroids plus cyclophosphamide. There were no significant differences in partial remission rate, complete remission rate and recurrent rate between the young patients with corticosteroids plus cyclophosphamide and the older patients with corticosteroids plus cyclophosphamide (18.2% vs. 35.8%, χ2=2.282, P=0.131; 63.6% vs. 43.4%, χ2=2.548, P=0.110; 9.1% vs. 9.4%, χ2=0.002, P=0.963). The time from the beginning of treatment to partial remission or complete remission was shorter in the young group than in the older group (3.0±1.5m vs. 5.3±5.0m, t=-2.594, P=0.012; 7.4±2.0m vs. 12±7m, t=-3.081, P=0.005). Conclusion The severity of nephrotic syndrome at the onset of the disease showed no difference between the young patients and the older patients. Young patients had lower proportion of hypertension and microscopical hematuria, higher estimated glomerular filtration rate and higher proportion of atypical MN. There were less arterial wall thickening and renal tubulointerstitial lesions in young patients. No difference in proportion of partial remission or complete remission existed between the two groups. The onset time was shorter in the young group than in the older patients. Corticosteroid monotherapy was effective to some of the young patients.
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