The clinical and pathological features of idiopathic membranous nephropathy in 246 Chinese adults
0
Citation
0
Reference
20
Related Paper
Abstract:
Objective: To investigate the clinical and pathological features of idiopathic membranous nephropathy (IMN) in Chinese adults. Methods: From 1986 to 1997, 264 patients with biopsy proven membranous nephropathy were selected in this study. Clinical and pathological features were compared between patients at different ages by t test. Results: (1) Patients from 21- 40 years old were inclined to membranous nephropathy. (2) One hundred and six of the patients had heavy proteinuria at presentation. Hypertension was found in 35 patients. Renal insuffeiency occurred in 7.7% of the patients in renal biopsy. Microscopic hematuria was found in 40.2% of the patients. Seventy-four patients presented nephrotic syndrome. (3) Eight of the 57 patients had deterioration of renal function during an average 49-month follow-up. (4) Patients of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ accounted for 42.3%, 48.7%, 6.0% and 3.0% respectively. Glomeruli IgG, C3 and C1qdeposition was found in 93.2%, 98.8% and 58.3% of the patients. Conclusion: Younger patients are inclined to membranous nephropathy. The incidence of hypertension, microscopic hematuria and renal insuffcieney is similar to that of other countries, while nephrotic syndrome is uncommon.Keywords:
Membranous Nephropathy
Cite
Cases of membranous nephropathy (MN) with crescent formation, in the absence of lupus, hepatitis B virus infection, anti-glomerular basement membrane (GBM) nephritis, or antineutrophil cytoplasmic antibody (ANCA), are on record. Clinical presentation and treatment outcomes in these patients are unclear. All patients with biopsy-proven MN diagnosed between years 2008 and 2014 and followed up were enrolled retrospectively. Patients with ANCA, anti-GBM antibodies, lupus, hepatitis B virus infection, or malignance were excluded. Clinical features and outcomes were compared between MN patients with and without crescent. Out of 401 consecutive patients with idiopathic MN, 28 (6.9%) showed crescent formation in 4.9% (2.2%–16.7%) of glomeruli. Mean age of these patients was 50.1 ± 11.1 years, and they presented with heavy proteinuria (6.5 ± 4.8 g/24 h) and hematuria; 21.4% of these patients had declined estimated glomerular filtration rate (<60 mL/min/1.73 m2) on biopsy. Anti-phospholipase A2 receptor antibody was detectable in 79.7% of these patients. These clinical features were comparable to the MN patients without crescent (P > 0.05). Twelve (42.9%) patients received steroids plus immunosuppressive therapy similar to that in patients without crescent (41.3%). Fewer patients with crescents achieved remission (67.9% vs 86.7%, P = 0.029). Crescent formation was a risk factor for no response to the treatments (odds ratio [OR] = 3.1, P = 0.033). Higher percentage of crescents predicted more risk for no remission (OR = 1.2, P = 0.038). Patients with crescents presented more frequencies of abnormal serum creatinine during follow-up (10.7% vs 1.3%, P = 0.031). Crescent formation was also a risk factor for worse renal outcome (relative risk = 10.2, P = 0.046). MN patients with crescents showed unfavorable therapeutic response and tended to have worse renal outcomes. More aggressive treatments and renal protection might be considered to improve the outcomes.
Membranous Nephropathy
Cite
Citations (14)
Membranous nephropathy in childhood is usually secondary to an underlying cause. Idiopathic membranous nephropathy is a rare cause of paediatric asymptomatic proteinuria/nephrotic syndrome. We reviewed the only three cases of membranous nephropathy followed in a paediatric hospital over the last ten years. All patients were female with mean age at diagnosis of 11.3 years (10-13 years). Patients 1 and 2 presented with steroid-resistant nephrotic syndrome. Patient 3 had a history of episodes of gross haematuria, and subnephrotic-range proteinuria refractory to enalapril and losartan. All patients had normal renal function. Patient 2 had hypertension and microscopic haematuria. Patients 1 and 2 underwent renal biopsy at an average of 51.5 days after initial symptoms; in patient 3, renal biopsy was performed seven years after initial presentation with episodes of gross haematuria, and five years after discovery of proteinuria. Histopathological features indicated membranous nephropathy; in patients 2 and 3, some findings suggested the coexistence of a systemic clinical condition. Secondary causes were sought in all patients. Six months after diagnosis, patient 1 developed facial skin lesions suggestive of discoid lupus erythematosus and later had positive autoantibodies (ANA, ENA, anti-SSA).
Membranous Nephropathy
Cite
Citations (0)
Membranous Nephropathy
Cite
Citations (0)
BackgroundStudies on biopsy-proven renal disease in the elderly (age ≥65 years) are extremely limited in China. The aim of this study was to examine the spectrum of renal diseases and their clinical presentations in elderly patients undergoing renal biopsy.
Cite
Citations (46)
Objective:To investigate the clinical and pathological features of idiopathic membranous nephropathy (IMN) in Chinese adults. Methods:Two hundred and sixty four patients with membranous nephropathy from 1986 to 1997 were selected in this study. The clinical and pathological finding were compared among patients in different age groups with student t test. Results: (1) Patients between 21 and 40 years old were inclined to membranous nephropathy. (2) One hundred and six out of 264 patients had heavy proteinuria at presentation. Hypertension was found in 35 out of 264 patients. Renal insuffiency occured in 7.7% of the patients at the time of renal biopsy.Microscopic hematuria was found in 40.2% of them. Seventy four patients(28.0%) presented nephrotic syndrome. (3) Six of 37 patients had deterioration of renal function during the mean period of 49 months follow up. (4) Patients of stage Ⅰ,Ⅱ,Ⅲand Ⅳ of IMN accounted for 42.3%, 48.7%, 6.0% and 3.0%, respectively. Depositions of glomerular IgG,C 3 and C 1q were found in 93.2%, 98.8% and 58.3% of the patients. Conclusion: IMN often occurs at the age of 21 to 40 years in Chinese patients. The incidence of hypertension,microscopic hematuria and renal insufficiency is similar to that of other countries, while nephrotic syndrome is uncommon. [
Membranous Nephropathy
Chronic renal insufficiency
Cite
Citations (0)
C1q nephropathy is a relatively rare idiopathic glomerulopathy characterized by mesangial immunoglobulin and complement deposits with dominance or co-dominance of C1q, with no evidence of systemic lupus erythematosus. We describe the incidence, clinical manifestation, histopathological features, and follow-up of patients with C1q nephropathy at our institute.Of 750 kidney biopsy specimens obtained in the period of January 2000 to December 2011, all the cases that meet the criteria for the diagnosis of C1q nephropathy were retrieved. The histological slides were examined and the clinical charts were reviewed by 2renal pathologists.We had 11 patients, all children, that met the criteria for the diagnosis of C1q nephropathy accounting for an incidence of 1.5%. The mean age at the time of presentation was 3.7 years and all the patients were presented with nephrotic syndrome. Two patients had microhematuria and 2 had hypertension. Histological examination of these cases showed variable degrees of mesangial cells hypercellularity and matrix expansion with focal segmental glomerulosclerosis observed in 2 cases. Nine patients were steroid resistant (82%) and 2 were steroid dependent. Six patients required immunosuppressive therapy and 1 patient developed end-stage renal disease.In our series, C1q nephropathy affected predominantly young children. Mesangioproliferative pattern was the most frequent histopathological finding in these patients. Clinically, despite steroid resistance, the patients had a relatively good outcome; the worst prognostic outcome was associated with collapsing glomerulopathy.
Microhematuria
Glomerulopathy
Membranous Nephropathy
Minimal change disease
Mesangial proliferative glomerulonephritis
Cite
Citations (4)
Summary: A survey of the medical records and renal biopsy reports of 41 patients with a diagnosis of membranous glomerulonephritis seen at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo was undertaken between 1961 and April 1992. Twenty‐three of these patients were found to have idiopathic membranous glomerulonephritis (IMG) and 22 of them were treated with corticosteroids and/or immunosuppressants. Data for these 22 patients showed that the age at clinical presentation was 36.3± 17.5 years, white skin colour predominated (14 patients), and 15 were males; nephrotic syndrome was the clinical presentation in 20 patients and proteinuria was accidentally discovered in two patients. On the first hospital visit 11 patients presented proteinuria of up to 3 g/24 h and 16 presented serum creatinine below 1.5 mg/dL, and 14 developed renal hypertension during follow up. Clinicalmorphological correlation permitted us to conclude (in agreement with the literature) that advanced patient age, intensity of proteinuria, serum creatinine levels above 1.5 mg/dL on the occasion of the first hospital visit, and arterial hypertension are clinical‐laboratory factors indicating a poor prognosis for IMG. More advanced staging of glomerular damage, presence of segmental mesangial sclerosis and tubulointerstitial involvement are microscopic factors indicating a poor prognosis for IMG.
Membranous Nephropathy
Presentation (obstetrics)
Cite
Citations (2)
Objective To explore epidemiological characteristics of Henan province kidney disease pathology in order to provide theoretical basis for diagnosis and treatment of kidney diseases. Methods To retrospectively analyse the renal pathological data of 6995 patients in our hospital who had renal biopsy from January 2009 to December 2012. Results( 1) The average age at renal biopsy was 34. 46 ± 16. 71( 1- 93) years old within 6995 patients( male 3636 and female 3359),it mainly occurred in the age group 20- 49 y,gender ratio was 1. 08∶ 1,and the male patients were earlier than the female ones( P =0. 001);( 2) Primary glomerular diseases( PGD) accounted for 66. 30%,secondary glomerular diseases( SGD) for31. 32%,and tubular-interstitial diseases for 2. 37%. The PGD in descending order of incidence were IgA nephropathy( IgAN 40. 34%),Minimal change glomerular disease( MCD 24. 29%) and membranous nephropathy( MN 13. 97%);( 3) The SGN in descending order of incidence were lupus nephritis( LN 34. 73%),Henoch Schonlein purpura nephritis( HSPN 19. 58%),hepatitis B virus-associated nephritis( HBVGN 13. 33%) and atypical membranous nephropathy( 10. 77%);( 4) The glomerular diseases induced by vascular disease in descending order of incidence were ischemic renal injury( 4. 84%),malignant hypertensive renal damage( 3. 47%),benign hypertensive renal arteriosclerosis( 1. 69%) and so forth;( 5) The glomerular diseases induced by metabolic diseases in descending order of incidence were diabetic nephropathy( DN 4. 84%),then,renal amyloidosis( 3. 01%),obesity-related kidney disease( 1. 55%) and so on. Conclusion Renal diseases often happened in young people in Henan province,and PGD was a dominating type in which IgA nephropathy was the most common,and the male patients suffered younger than the female ones. Lupus nephritis was the most common pathological type of SGD which occurred more frequently in female patients.
Membranous Nephropathy
Hypertensive Nephropathy
Nephritis
Renal pathology
Minimal change disease
Cite
Citations (0)
The clinical course of 139 patients (77 male, 62 female) with idiopathic membranous glomerulonephritis is reviewed. The median duration of follow-up was 52 months; 45% and 25% were followed for more than 5 and 10 years respectively. The median age at presentation was 36. Fifty-four percent of patients had the nephrotic syndrome at presentation. Half of the patients were treated at some stage with cyclophosphamide or corticosteroids. During the course of follow-up some deterioration in renal function occurred in only 20% of patients. The patients who suffered deterioration in renal function were mainly male and had significantly worse renal function and a higher incidence of the nephrotic syndrome than the other patients at presentation. Only 7 male patients (5%) developed terminal renal failure during follow-up and one female presented in terminal renal failure. Survival was 88% and 81% at 5 and 10 years. The median predicted (or actual) time for development of terminal renal failure in patients with progressive deterioration was 7.3 years. These data are in accord with other recently published series which have described a relatively benign prognosis for idiopathic membranous glomerulonephritis.
Idiopathic Nephrotic Syndrome
Membranous Nephropathy
Cite
Citations (53)
Objective To explore the pathology and prognosis of children with idiopathic membranous nephropathy(IMN).Methods Clinical manifestations,pathology,treatment and prognosis of 16 children with IMN were reviewed to explore the prognosis of children's idiopathic membranous nephropathy.Results From 1979 to July 2010,consecutive 16 patients diagnosed as IMN were analyzed,accounting for 0.94% of all renal biopsy patients,with the ratio of male:female:10:6,the median age:(5.2±2.6) years.Eleven patients were with nephritic syndrome(68.8%),5 with asymptomatic proteinuria(31.2%),2 children with hypertension(12.5%),2 children with renal insufficiency(12.5%).Fourteen of 16 patients received phathological examination under electronic microscopy,showing that 6 were graded as stage Ⅰ(42.9%),6 as stage Ⅰ-Ⅱ(42.9%),1 as stage Ⅱ(7.1%),1 as stage Ⅱ-Ⅲ(7.1%).No tubular atrophy or interstitial fibrosis were observed.For the patients having proteinuria50 mg·kg-1,no steroids or immunosuppressants were provided for treatment.The patients having proteinuria50 mg·kg-1 were given steroids(2 mg·kg-1·d-1).Immunosuppressants were given to non-responders or reliers to steroids.After(34.0±18.7) months,14 patients were all remitted,and had normal renal function.Conclusions IMN mainly presents as nephritic syndrome.Better prognosis can be expected among patients with younger age,lower pathologic grade,and not combined with interstitial fibrosis.Diagnosis and treatment early can improve the prognosis of children's idiopathic membranous nephropathy.
Nephritic syndrome
Membranous Nephropathy
Renal pathology
Cite
Citations (0)