Relationship between hyperuricemia and prognosis of elderly patients with idiopathic membranous nephropathy
Objective To analyze the influencing factors of hyperuricemia in elderly patients(aged＞60 years)with idiopathic membranous nephropathy(IMN),and to explore the influence of hyperuricemia on the prognosis of elderly patients with IMN.Methods Totally 336 elderly patients with IMN in Chinese PLA General Hospital from January 2011 to April 2018 were divided into hyperuricemia group(n=80)and normal uric acid group(n=256).The clinical data of body mass index,duration of nephropathy,comorbidities(hypertension,diabetes),stage of chronic kidney disease,blood pressure,hemoglobin,fasting plasma glucose,serum creatinine,blood albumin,blood uric acid,serum urea and total cholesterol at admission were compared between two groups.Percutaneous renal biopsy was performed in both groups.Ehrenreich-Churg stage,glomerular sclerosis score,glomerular segmentosclerosis/balloon adhesion score,renal tubular atrophy/interstitial fibrosis score,renal interstitial inflammatory cell infiltration score,renal tubular interstitial score,renal vascular lesion score and complement C3 deposition were recorded.Multivariate logistic regression analysis was conducted to analyze the influencing factors of hyperuricemia in elderly IMN patients.Hyperuricemia group received urate-lowering therapy besides the administrations of renin-angiotensin-aldosterone system inhibitors,glucocorticoids and calcinurin inhibitors in two groups.The follow-up survey was done for 6 to 24 months,and the overall response rate at the latest follow-up was recorded.Multivariate Cox regression was used to analyze the influencing factors of non-response in elderly IMN patients.Results(1)The body mass index,serum urea and total cholesterol were higher in hyperuricemia group[(26.52±3.83)kg/m2,6.52(5.38,8.69)mmol/L,(6.90±2.34)mmol/L]than those in normal uric acid group[(25.11±4.53)kg/m2,5.52(4.39,7.24)mmol/L,(6.21±2.07)mmol/L](P＜0.05),and there were no significant differences in the duration of nephropathy,rates of hypertension and diabetes,stage of chronic kidney disease,incidence of nephrotic syndrome and admission baseline data including systolic blood pressure,diastolic blood pressure,hemoglobin,fasting plasma glucose,creatinine,albumin,estimated glomerular filtration rate,phospholipase A2 receptor antibody positive rate,24-h urine protein,cystatin C,N-acetylglucosidase,IgA,IgG,IgM,complement C3,complement C4,triacylglycerol,high-density lipoprotein cholesterol levels between two groups(P＞0.05).(2)The rate of renal interstitial inflammatory cell infiltration score 0 was lower in hyperuricemia group(6.3％)than that in normal uric acid group(16.8％)(x2=5.537,P=0.019),the rates of renal interstitial inflammatory cell infiltration score 1 and complement C3 deposition intensity++were higher in hyperuricemia group(86.2％,20.0％)than those in normal uric acid group(74.2％,10.6％)(x2=4.995,P=0.025;x2=4.881,P=0.027),and there were no significant differences in the treatment plan,Ehrenreich-Churg stage,glomerular sclerosis score,glomerular segmentosclerosis/balloon adhesion score,renal tubular atrophy/interstitial fibrosis score,renal tubular interstitial score,renal vascular lesion score,renal interstitial inflammatory cell infiltration score 2 and 3,and rates of complement C3 deposition intensity 0 and+between two groups(P＞0.05).(3)Body mass index(OR=1.076,95％CI:1.003-1.048,P=0.045)and serum urea(OR=3.424,95％CI:1.275-9.195,P=0.015)were the influencing factors of hyperuricemia in elderly patients with IMN.(4)Till April 2018,221 patients were lost to follow-up,and the average follow-up lasted for 8(6,17)months in the other 115 patients including 27 patients in hyperuricemia group and 88 in normal uric acid group.The overall response rate was lower in hyperuricemia group(59.3％)than that in normal uric acid group(81.8％)(x2=5.852,P=0.016).(5)Total cholesterol(HR=0.781,95％CI:0.612-0.996,P=0.047),complement C3 deposition intensity(HR=0.259,95％CI:0.075-0.892,P=0.032)were the influencing factors of non-response in elderly IMN patients.Conclusions The elderly IMN patients with increased body mass index and urea level are prone to hyperuricemia.Hyperuricemia can affect the prognosis of elderly IMN patients.The high total cholesterol level and complement C3 deposition intensity increase the risk of poor prognosis.
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