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Clinical and pathological features of idiopathic membranous nephropathy with focal segmental sclerosis
Jiatong Li1,2, Bing Chen3, Caifeng Gao4
1Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250021, People's Republic of China.
Background:
The goal of this study was to investigate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesions.
Methods:
In our hospital, 305 patients with nephrotic syndrome confirmed as IMN by renal biopsy were divided into a non-focal segmental lesion group (FSGS- group) and a focal segmental glomerulosclerosis (FSGS) group (FSGS+ group) and retrospectively analyzed. In all, 180 patients were followed for periods ranging from 6 months to 2 years. The general clinicopathological data of both groups were compared, and the effects of different treatment schemes on the prognosis of both groups were observed.
Results:
The FSGS+ group had a longer disease course, higher blood pressure levels, and higher serum creatinine and β2-microglobulin levels than did the FSGS- group (all P < 0.05). Pathologically, the FSGS+ group had increased glomerular sclerosis, glomerular mesangial hyperplasia, and acute and chronic tubular lesion rates (all P < 0.05). The remission rate was lower in the FSGS+ group than in the FSGS- group (64.7% vs 82.2%) and, among patients in the FSGS+ group, was lower in patients treated with calmodulin inhibitors than in those treated with cyclophosphamide (P < 0.01). Survival analysis showed that the FSGS+ group had a poor prognosis (χ2 = 4.377, P = 0.036), and risk factor analysis suggested that age at renal biopsy (P = 0.006), 24-h urinary protein quantity (P = 0.01), chronic tubulointerstitial lesions (P = 0.055), and FSGS lesions (P = 0.062) were risk factors for worsening renal condition; furthermore, 24-h urinary protein quantity was an independent risk factor for worsening renal condition.
Conclusions:
Membranous nephropathy with FSGS is a risk factor, but not an independent risk factor, for IMN. Patients with membranous nephropathy with FSGS often present hypertension and tubule injury. The nonselective drug cyclophosphamide is preferred, and calcineurin inhibitors should be used with caution.
Insights
Idiopathic membranous nephropathy (IMN) with focal segmental glomerulosclerosis (FSGS) indicates a poorer prognosis and higher risk of kidney disease progression. Cyclophosphamide is a preferred treatment over calcineurin inhibitors for these patients.
Area of Science:
- Nephrology
- Pathology
- Clinical Medicine
Background:
- Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults.
- Focal segmental glomerulosclerosis (FSGS) is a potential complication or co-existing lesion in IMN.
- Understanding the impact of FSGS on IMN prognosis is crucial for patient management.
Purpose of the Study:
- To investigate the clinical, pathological, and prognostic differences between IMN patients with and without focal segmental lesions.
- To evaluate the impact of different treatment strategies on the outcomes of IMN patients with FSGS.
Main Methods:
- Retrospective analysis of 305 nephrotic syndrome patients with biopsy-confirmed IMN.
- Division into groups based on the presence (FSGS+) or absence (FSGS-) of focal segmental lesions.
- Follow-up of 180 patients for 6 months to 2 years to assess clinical and pathological data and treatment effects.
Main Results:
- The FSGS+ group exhibited longer disease duration, higher blood pressure, elevated serum creatinine, and increased β2-microglobulin.
- Pathological findings in the FSGS+ group included more glomerular sclerosis, mesangial hyperplasia, and tubular lesions.
- The FSGS+ group had a lower remission rate (64.7% vs 82.2%) and poorer survival outcomes, with 24-hour urinary protein quantity identified as an independent risk factor for worsening renal condition.
Conclusions:
- FSGS is a significant risk factor for poor prognosis in IMN, characterized by hypertension and tubule injury.
- Nonselective drugs like cyclophosphamide are recommended, while calcineurin inhibitors should be used cautiously in IMN patients with FSGS.
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