Clinicopathological features and prognostic analysis of idiopathic membranous nephropathy with anemia
Objective To compare the clinicopathological features of patients with idiopathic membranous nephropathy(IMN)complicated with anemia versus without anemia,and to explore the prognosis.Methods Totally 403 patients with IMN were treated in Chinese PLA General Hospital from January,2011 to April,2018,and were divided into anemia group(n=58)and non-anemia group(n=344).The patients in two groups received standard treatment according to guidelines of Kidney Disease:Impioving Global Outcomes organization,and anemia group was treated with erythropoietin,ferrous succinate tablets or iron sucrose injections based on the severity of anemia.The age,course of disease,body mass index,blood pressure,stage of chronic kidney disease(CKD),and hematuria score were compared between two groups.The admission hemoglobin,fasting plasma glucose,albumin,blood urea,blood creatinine,uric acid,cystatin C,N-acetyl-β-glucosaminidase,estimated glomerular filtration rate,total cholesterol,triacylglycerol,D-dimer,C-reactive protein,immunoglobulin(Ig)A,IgG,IgM,complement C3,complement C4,24-h urinary protein quantification,and renal histopathological indexes were recorded in two groups.The 24-month complete remission rate was compared between two groups.The incidence of end event was compared between two groups.Results(1)The course of disease was longer in anemia group[6(2,12)months]than that in non-anemia group[3(1,6)months](P＜0.05).The systolic blood pressure,blood urea,blood creatinine,cystatin C,D-dimer,C-reactive protein and 24-h urinary protein quantification were higher in anemia group[(136.09±18.88)mmHg,(6.07±3.27)mmol/L,(88.64±43.98)μmol/L,(1.27±0.62)mg/L,1.06(0.47,2.70)mg/L,0.36(0.32,0.41)mg/L,(6.08±3.47)g]than those in non-anemia group[(129.90±17.31)mmHg,(4.77±1.68)mmol/L,(73.89±19.80)μmol/L,(0.99±0.30)mg/L,0.55(0.36,1.31)mg/L,0.32(0.10,0.34)mg/L,(4.82±2.55)g](P＜0.05).The levels of hemoglobin,uric acid,serum albumin,IgA and complement C3 as well as proportion of CKD 1 were lower in anemia group[105.0(94.5,111.3)g/L,(294.29±92.20)μmol/L,(21.66±6.14)g/L,(171.54±86.35)g/L,(98.24±25.64)g/L,51.7％]than those in non-anemia group[140.0(130.0,150.0)g/L,(349.82±92.18)μmol/L,(26.07±6.32)g/L,(210.61±80.09)g/L,(115.37±28.42)g/L,73.8％](P＜0.05).(2)There were significant differences in the Ehrenreich-Churg stage,positive rate of complement C3,glomerular sclerosis score,glomerular segmental sclerosis score,tubular atrophy/interstitial fibrosis score,inflammatory cell infiltration score,renal vascular score,and positive rates of C1q and IgM between two groups(P＜0.05),and the positive rates of IgA and complement C4 showed no significant differences between two groups(P＞0.05).(3)The proportions of patients receiving renin-angiotensin-aldosterone system inhibitors,glucocorticoids and/or immunosuppressant therapy showed no significant differences between two groups(P＞0.05).After 24-month treatment,the complete remission rate showed no significant difference between anemia group(34.5％)and non-anemia group(39.5％)(P＞0.05).The follow-up till April,2020 showed a higher incidence rate of end-stage renal disease in anemia group(6.9％)than that in non-anemia group(1.2％)(P＜0.05),and no significant difference in the mortality from treatment-related serious adverse events between two groups(1.7％vs.0.3％)(P＞0.05).Conclusions The kidney injury severity of IMN patients with anemia is higher than that of those without anemia,and active correction of anemia can improve the complete remission rate,lower the incidence of end-stage renal disease and improve the prognosis of IMN patients.
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